Basic Information
| Provider Information | |||||||||
| NPI: | 1811996663 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JARRETT | ||||||||
| FirstName: | ALTHEA | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 99213 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761990213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6828851855 | ||||||||
| FaxNumber: | 6828857347 | ||||||||
| Practice Location | |||||||||
| Address1: | 2727 E SOUTHLAKE BLVD | ||||||||
| Address2: | |||||||||
| City: | SOUTHLAKE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760926613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6828856000 | ||||||||
| FaxNumber: | 6828856026 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2005 | ||||||||
| LastUpdateDate: | 04/21/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | L0830 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 147102102 | 05 | TX | MEDICAID | 147102114 | 05 | TX | MEDICAID | 147102101 | 05 | TX | MEDICAID | 147102113 | 05 | TX | MEDICAID | 147102104 | 05 | TX | MEDICAID | 147102105 | 05 | TX | MEDICAID | 147102106 | 05 | TX | MEDICAID | 147102111 | 05 | TX | MEDICAID | 147102112 | 05 | TX | MEDICAID | 147102109 | 05 | TX | MEDICAID | 147102107 | 05 | TX | MEDICAID | 147102115 | 05 | TN | MEDICAID |