Healthcare Provider Details

I. General information

NPI: 1093363145
Provider Name (Legal Business Name): JACLYN PERKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2019
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 SUNSET BLVD
HOUSTON TX
77005-1798
US

IV. Provider business mailing address

1701 SUNSET BLVD
HOUSTON TX
77005-1798
US

V. Phone/Fax

Practice location:
  • Phone: 713-526-5511
  • Fax: 713-520-4755
Mailing address:
  • Phone: 713-526-5511
  • Fax: 713-520-4755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: