Provider Demographics
NPI:1386634657
Name:DRISKELL, JENNIFER MARSHALL (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARSHALL
Last Name:DRISKELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 CLARK CV
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-3264
Mailing Address - Country:US
Mailing Address - Phone:512-295-5401
Mailing Address - Fax:
Practice Address - Street 1:1340 WONDER WORLD DR
Practice Address - Street 2:BUILDING 4 SUITE 200
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7598
Practice Address - Country:US
Practice Address - Phone:512-392-1718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4293207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139247404Medicaid
TX139247406OtherCSHCN
TX86872JOtherBCBS
TX139247404Medicaid
TXC15397Medicare UPIN
TX930066297Medicare PIN