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NPI Code Detail

MEDICARE: DR. JACQUELINE ANN FENN MD PHD

MEDICARE: DR. JACQUELINE ANN FENN MD PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0015XPsychosomatic Medicine PhysicianV7879TX
22084P0800XPsychiatry PhysicianV7879TX

General Provider Information

NPI Number : 1235710666
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACQUELINE ANN FENN MD PHD
Provider Business Mailing Address
First Line : 1 BAYLOR PLZ
Second Line :
City : HOUSTON
State : TX
Zip : 77030-3411
Country : US
Telephone Number : 773-892-9187
Fax Number :
Provider Business Practice Location Address
First Line : 1502 TAUB LOOP
Second Line :
City : HOUSTON
State : TX
Zip : 77030-1608
Country : US
Telephone Number : 713-873-4900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2021
Last Update Date : 02/02/2026

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