Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 707116 | TX |
N | 363LF0000X | Nurse Practitioner - Family Medicine | NP19344 | CA |
NPI | 1013167477 |
---|---|
Provider Name | Ms. Lea Ann Jackson |
First Address | Spring, TX 77389 |
Second Address | Spring, TX 77389 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2008 |
Last Update Date | 15/10/2019 |