Provider Demographics
NPI:1891042925
Name:SCHALLENBERG, JACKLYN RENEE
Entity Type:Individual
Prefix:
First Name:JACKLYN
Middle Name:RENEE
Last Name:SCHALLENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JACKLYN
Other - Middle Name:RENEE
Other - Last Name:OWINGS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78291-0087
Mailing Address - Country:US
Mailing Address - Phone:210-358-9174
Mailing Address - Fax:210-358-5753
Practice Address - Street 1:2121 SW 36TH ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78237-3360
Practice Address - Country:US
Practice Address - Phone:210-358-5100
Practice Address - Fax:210-358-5157
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07952363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant