Provider Demographics
NPI:1902006810
Name:SKELTON, JOLIE KATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:JOLIE
Middle Name:KATHERINE
Last Name:SKELTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 THORPE LANE
Mailing Address - Street 2:STE 105 PMB 1020
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-5451
Mailing Address - Country:US
Mailing Address - Phone:830-299-4968
Mailing Address - Fax:
Practice Address - Street 1:1528 E COMMON ST STE 10
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3336
Practice Address - Country:US
Practice Address - Phone:830-299-4968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN22632084P0800X
IL036.1459812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX293198201Medicaid
TXTXB144325Medicare PIN