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General NPI Number Information
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NPI Number | 1013220268
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Entity Type | Individual
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Provider Name | CHERYL JACKSON FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/16/2010
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Last Update Date | 08/22/2013
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Provider Practice Location Address
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Address Line | 5002 S LAKE HOUSTON PKWY STE 7
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City | HOUSTON
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State | TX
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Zip | 77049-2631
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Country | US
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Telephone | 832-831-9390
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Fax | 832-831-9392
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Provider Business Mailing Address
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Address Line | 1922 BROWN SCHOOL CT
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City | RICHMOND
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State | TX
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Zip | 77406-6727
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Country | US
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Telephone | 832-831-9390
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Fax | 832-831-9392
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 673649
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License Number State | TX
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