Provider Demographics
NPI:1568626430
Name:RICHARDS, JACLYN (MD)
Entity Type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JACLYN
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:205 E UNIVERSITY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-6814
Mailing Address - Country:US
Mailing Address - Phone:512-868-1124
Mailing Address - Fax:512-868-9894
Practice Address - Street 1:205 E UNIVERSITY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-6814
Practice Address - Country:US
Practice Address - Phone:512-868-1124
Practice Address - Fax:512-868-9894
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104017208000000X
TXQ1893208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics