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General NPI Number Information
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NPI Number | 1497398218
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Entity Type | Individual
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Provider Name | LESLIE DENISE JACKSON CNM
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Gender | Female
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Dates
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Enumeration Date | 10/24/2019
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 1001 W RANDOL MILL RD
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City | ARLINGTON
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State | TX
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Zip | 76012-2513
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Country | US
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Telephone | 817-962-0004
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Fax |
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Provider Business Mailing Address
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Address Line | 4708 ENGLISHTOWN DR
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City | ARLINGTON
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State | TX
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Zip | 76016-1880
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Country | US
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Telephone | 734-444-9098
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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 | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number |
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License Number State | TX
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