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NPI Code Detail

MEDICARE: LAURA L JACKSON APRN, FNP

MEDICARE: LAURA L JACKSON APRN, FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerAP134028TX

General Provider Information

NPI Number : 1013443589
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA L JACKSON APRN, FNP
Provider Business Mailing Address
First Line : 5002 COWHORN CREEK RD
Second Line :
City : TEXARKANA
State : TX
Zip : 75503-9766
Country : US
Telephone Number : 903-614-3000
Fax Number : 903-614-3525
Provider Business Practice Location Address
First Line : 2717 SUMMERHILL RD
Second Line :
City : TEXARKANA
State : TX
Zip : 75503-3957
Country : US
Telephone Number : 903-792-1404
Fax Number : 903-792-2681
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2017
Last Update Date : 03/12/2026

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