Provider Demographics
NPI:1528574795
Name:KLEIN, JAQUATTA LYNN (BBS, PT, FN, ETS)
Entity Type:Individual
Prefix:MRS
First Name:JAQUATTA
Middle Name:LYNN
Last Name:KLEIN
Suffix:
Gender:F
Credentials:BBS, PT, FN, ETS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3036 THICKET BEND CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-5508
Mailing Address - Country:US
Mailing Address - Phone:817-550-4320
Mailing Address - Fax:
Practice Address - Street 1:1006 N BOWEN RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2826
Practice Address - Country:US
Practice Address - Phone:817-550-4320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-23
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health