Healthcare Provider Details

I. General information

NPI: 1992012470
Provider Name (Legal Business Name): JENNIFER MCCRACKEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2010
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 UNIVERSITY BLVD
GALVESTON TX
77555-0550
US

IV. Provider business mailing address

301 UNIVERSITY BLVD
GALVESTON TX
77555-0550
US

V. Phone/Fax

Practice location:
  • Phone: 409-772-3410
  • Fax: 409-772-9532
Mailing address:
  • Phone: 409-772-3410
  • Fax: 409-772-9532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberP6867
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: