Healthcare Provider Details

I. General information

NPI: 1952092256
Provider Name (Legal Business Name): AKEIBIA RASHAE JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 E CENTRAL TEXAS EXPY STE 101
KILLEEN TX
76543-7326
US

IV. Provider business mailing address

101 W LOUIS HENNA BLVD STE 300
AUSTIN TX
78728-1203
US

V. Phone/Fax

Practice location:
  • Phone: 254-741-6641
  • Fax:
Mailing address:
  • Phone: 512-492-3743
  • Fax: 512-593-4444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1120484
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: