Provider Demographics
NPI:1952793895
Name:STEPHENSON, JACQUELINE JEAN (DO)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:JEAN
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JACQUELINE
Other - Middle Name:JEAN
Other - Last Name:SPEER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:800 PEAKWOOD DR STE 8B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2904
Mailing Address - Country:US
Mailing Address - Phone:281-580-6797
Mailing Address - Fax:281-580-6693
Practice Address - Street 1:800 PEAKWOOD DR STE 8B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2904
Practice Address - Country:US
Practice Address - Phone:281-580-6693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS019754208600000X
390200000X
TXS3751208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program