Basic Information
| Provider Information | |||||||||
| NPI: | 1386634657 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DRISKELL | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | MARSHALL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 935 CLARK CV | ||||||||
| Address2: | |||||||||
| City: | BUDA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786103264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122955401 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1340 WONDER WORLD DR | ||||||||
| Address2: | BUILDING 4 SUITE 200 | ||||||||
| City: | SAN MARCOS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786667598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123921718 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2005 | ||||||||
| LastUpdateDate: | 03/04/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | H4293 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 139247404 | 05 | TX | MEDICAID | 139247406 | 01 | TX | CSHCN | OTHER | 86872J | 01 | TX | BCBS | OTHER |