Healthcare Provider Details

I. General information

NPI: 1720557671
Provider Name (Legal Business Name): JANECIA SONYELL JACKSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2018
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 CARTWRIGHT RD STE 302
MISSOURI CITY TX
77459-3539
US

IV. Provider business mailing address

4501 CARTWRIGHT RD STE 302
MISSOURI CITY TX
77459-3539
US

V. Phone/Fax

Practice location:
  • Phone: 903-414-5729
  • Fax:
Mailing address:
  • Phone: 903-414-5729
  • Fax: 903-313-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberC-APN.0100860-C-NP
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP139351
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: