Healthcare Provider Details

I. General information

NPI: 1609300102
Provider Name (Legal Business Name): ANGEL JACKSON PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGEL CHAMBERS DC

II. Dates (important events)

Enumeration Date: 04/12/2017
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5119 BECKWITH BLVD STE 105
SAN ANTONIO TX
78249-2277
US

IV. Provider business mailing address

911 CENTRAL PKWY N STE 300
SAN ANTONIO TX
78232-5053
US

V. Phone/Fax

Practice location:
  • Phone: 210-366-3700
  • Fax: 210-265-1442
Mailing address:
  • Phone: 800-404-6050
  • Fax: 866-313-3397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1024242
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number13441
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: