Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | N0125 | TX |
N | 208D00000X | General Practice Physician | N0125 | TX |
NPI | 1013111681 |
---|---|
Provider Name | Dr. Lindsey Nicole Jackson |
First Address | Friendswood, TX 77546-3823 |
Second Address | Houston, TX 77070-4951 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2007 |
Last Update Date | 05/03/2012 |