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NPI Code Detail

MEDICARE: JACKIE L FIRKINS

MEDICARE: JACKIE L FIRKINS
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
1385HR2055XChild Mental Illness Respite Care4393AZ

General Provider Information

NPI Number : 1831343193
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACKIE L FIRKINS
Provider Business Mailing Address
First Line : 12335 E SUTTER MILL ST
Second Line :
City : TUCSON
State : AZ
Zip : 85749-9724
Country : US
Telephone Number : 520-207-1333
Fax Number :
Provider Business Practice Location Address
First Line : 12335 E SUTTER MILL ST
Second Line :
City : TUCSON
State : AZ
Zip : 85749-9724
Country : US
Telephone Number : 520-207-1333
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2008
Last Update Date : 11/12/2008

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Directions to “ JACKIE L FIRKINS ” Practice Location

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