MEDICARE: JACLYN STACY FAULK DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RS0012X	Sleep Medicine (Internal Medicine) Physician	26918	MS
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1578093126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYN STACY FAULK DO

Provider Business Mailing Address
First Line	:	1100 WILFORD HALL LOOP
Second Line	:
City	:	JBSA LACKLAND
State	:	TX
Zip	:	78236-5638
Country	:	US
Telephone Number	:	210-292-4277
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 WILFORD HALL LOOP
Second Line	:
City	:	JBSA LACKLAND
State	:	TX
Zip	:	78236-5638
Country	:	US
Telephone Number	:	210-292-4277
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2017
Last Update Date	:	05/29/2026

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Directions to “ JACLYN STACY FAULK DO” Practice Location

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