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General NPI Number Information
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NPI Number | 1003638164
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Entity Type | Individual
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Provider Name | MONICA S JACKSON PMHNP
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Gender | Female
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Dates
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Enumeration Date | 10/29/2024
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 93 ISAACKS RD
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City | HUMBLE
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State | TX
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Zip | 77338-4740
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Country | US
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Telephone | 281-446-7159
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Fax |
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Provider Business Mailing Address
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Address Line | 12500 BARKER CYPRESS RD APT 3205
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City | CYPRESS
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State | TX
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Zip | 77429-8243
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1072170
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License Number State | TX
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