MEDICARE: KENYA JACKSON

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
1	363LF0000X	Family Nurse Practitioner	AP131762	TX

General Provider Information

NPI Number	:	1801346150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENYA JACKSON

Provider Business Mailing Address
First Line	:	1941 EAST RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-6010
Country	:	US
Telephone Number	:	713-486-2700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1941 EAST RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-6010
Country	:	US
Telephone Number	:	713-486-2700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2016
Last Update Date	:	03/13/2026

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