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General NPI Number Information
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NPI Number | 1437877362
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Entity Type | Organization
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Legal Business Name | LEE JACKSON ENTERPRISES
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Dates
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Enumeration Date | 08/17/2022
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 3626 N HALL ST STE 610
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City | DALLAS
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State | TX
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Zip | 75219-5131
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Country | US
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Telephone | 866-301-1456
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Fax | 469-898-6344
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Provider Business Mailing Address
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Address Line | 3626 N HALL ST STE 610
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City | DALLAS
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State | TX
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Zip | 75219-5131
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Country | US
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Telephone | 866-301-1456
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Fax | 469-898-6344
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | NIKIA AUTRY
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Credential | NIKIA A AUTRY
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Telephone | 866-301-1456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 224900000X
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Taxonomy Name | Mastectomy Fitter
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number |
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License Number State |
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