Provider Demographics
NPI:1689004970
Name:BROWN, JACKIE
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5039 REED RD
Mailing Address - Street 2:BLDG 1
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77033-4000
Mailing Address - Country:US
Mailing Address - Phone:832-670-6447
Mailing Address - Fax:
Practice Address - Street 1:5039 REED RD
Practice Address - Street 2:BLDG 1
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77033-4000
Practice Address - Country:US
Practice Address - Phone:832-670-6447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care