Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 552302 | TX |
NPI | 1033449012 |
---|---|
Provider Name | Jane Flatley Jackson |
First Address | El Paso, TX 79922-1751 |
Second Address | El Paso, TX 79912-1623 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2010 |
Last Update Date | 10/12/2010 |