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NPI Code Detail

MEDICARE: MRS. KATRINA MARIE JACKSON PA-C

MEDICARE: MRS. KATRINA MARIE JACKSON PA-C
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
1363A00000XPhysician AssistantPA030501TX

General Provider Information

NPI Number : 1073735445
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATRINA MARIE JACKSON PA-C
Provider Business Mailing Address
First Line : 2523 POTOMAC DR
Second Line :
City : LEAGUE CITY
State : TX
Zip : 77573-4847
Country : US
Telephone Number : 281-557-7640
Fax Number :
Provider Business Practice Location Address
First Line : 2911 S SHORE BLVD STE 190
Second Line :
City : LEAGUE CITY
State : TX
Zip : 77573-3919
Country : US
Telephone Number : 281-538-8188
Fax Number : 281-538-8189
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2007
Last Update Date : 10/30/2009

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Directions to “ MRS. KATRINA MARIE JACKSON PA-C” Practice Location

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