Healthcare Provider Details

I. General information

NPI: 1114229366
Provider Name (Legal Business Name): JACKIE LYNN SNELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2010
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N FRIENDSWOOD DR
FRIENDSWOOD TX
77546-3747
US

IV. Provider business mailing address

PO BOX 392929
PITTSBURGH PA
15251-9900
US

V. Phone/Fax

Practice location:
  • Phone: 713-461-2915
  • Fax: 713-461-5307
Mailing address:
  • Phone: 713-461-2915
  • Fax: 713-461-5307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberK7903
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: