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General NPI Number Information
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NPI Number | 1710053319
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Entity Type | Individual
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Provider Name | JILL W. BRACKEN D.O.
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Gender | Female
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 01/30/2008
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Provider Practice Location Address
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Address Line | 3200 SOUTHERN DR STE 107
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City | GARLAND
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State | TX
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Zip | 75043-1549
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Country | US
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Telephone | 972-278-5385
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Fax | 972-692-8687
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Provider Business Mailing Address
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Address Line | 3200 SOUTHERN DR STE 107
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City | GARLAND
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State | TX
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Zip | 75043-1549
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Country | US
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Telephone | 972-278-5385
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Fax | 972-692-8687
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | K6992
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License Number State | TX
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