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General NPI Number Information
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NPI Number | 1922021070
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Entity Type | Individual
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Provider Name | JACKIE LYNN AGEE M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 12/06/2013
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Provider Practice Location Address
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Address Line | 650 HOWE AVENUE,,SUITE 100
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City | SACRAMENTO
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State | CA
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Zip | 95825
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Country | US
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Telephone | 916-924-9337
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Fax | 916-924-8281
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Provider Business Mailing Address
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Address Line | 650 HOWE AVENUE., SUITE 100
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City | SACRAMENTO
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State | CA
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Zip | 95825
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Country | US
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Telephone | 916-924-9337
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Fax | 916-924-8281
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | G37462
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A47099
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License Number State | CA
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