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Jaclyn Stacy Faulk

Internal Medicine

Allopathic & Osteopathic Physicians

1100 Wilford Hall Loop, Jbsa Lackland, TX 78236-5638

PECOS Enrollment

This provider is enrolled in PECOS as JACLYN FAULK.

Based on the most recent information from CMS, provider Jaclyn Stacy Faulk is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1578093126
Provider Type
Individual
Full Name
Faulk, Jaclyn Stacy
Credential
DO

Gender
Female
Sole Proprietor
No
Enumeration Date
6/15/2017
Last Updated
7/16/2024

Contact Information

Practice Location

1100 Wilford Hall Loop, Jbsa Lackland, TX 78236-5638

(210) 292-4277

Unlisted Fax

Mailing Location

1100 Wilford Hall Loop, Jbsa Lackland, TX 78236-5638

(210) 292-4277

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License 26918 Mississippi
Code 390200000X	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer

Jaclyn Stacy Faulk

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Fiechtner, Bridget Kaye

Bapodra, Aneesh Atul

Danchi, Henry

Nassery, Daniel Richard

Rodrigues, Matthew Bryant

Miller, Alisa Anne

Young, David G

Hancock, Kristen Rae

Oberg, Martin R

Yoosefian, Farida N/A