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1003638164 NPI number — MONICA S JACKSON PMHNP

NPI Number: 1003638164
Health Care Provider/Practitioner: MONICA S JACKSON PMHNP

Information about “1003638164” NPI (MONICA S JACKSON PMHNP) exists in 1003638164 in HTML format HTML  |  1003638164 in plain Text format TXT  |  1003638164 in PDF (Portable Document Format) PDF  |  1003638164 in an XML format XML  formats.

NPI Number : 1003638164 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1003638164",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JACKSON",
    "FirstName": "MONICA",
    "MiddleName": "S",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PMHNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "12500 BARKER CYPRESS RD APT 3205",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CYPRESS",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "77429-8243",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "93 ISAACKS RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HUMBLE",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "77338-4740",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "281-446-7159",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/29/2024",
    "LastUpdateDate": "08/29/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LP0808X",
        "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
        "LicenseNumber": "1072170",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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