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General NPI Number Information
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NPI Number | 1639041197
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Entity Type | Organization
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Legal Business Name | TEXAS TONE DERMATOLOGY
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Dates
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Enumeration Date | 09/23/2025
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 9423 S US HIGHWAY 69
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City | HUNTINGTON
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State | TX
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Zip | 75949-1515
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Country | US
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Telephone | 936-955-5541
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Fax | 936-955-5540
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Provider Business Mailing Address
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Address Line | 109 WOODRUFF LN
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City | SAN AUGUSTINE
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State | TX
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Zip | 75972-2637
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Country | US
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Telephone | 936-955-5540
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Fax | 936-955-5541
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Authorized Official
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Title or Position | OWNER
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Name | KELLY JACKSON
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Credential | FNP-C
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Telephone | 936-585-2516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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