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General NPI Number Information
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NPI Number | 1548843527
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Entity Type | Individual
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Provider Name | VINEY JACKSON
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Gender | Female
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Dates
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Enumeration Date | 04/28/2021
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Last Update Date | 04/28/2021
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Provider Practice Location Address
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Address Line | 6901 LOMA VISTA DR
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City | FORT WORTH
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State | TX
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Zip | 76133-6428
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Country | US
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Telephone | 682-253-4807
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Fax | 682-224-2997
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Provider Business Mailing Address
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Address Line | 3701 ALTAMESA BLVD # 331652
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City | FORT WORTH
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State | TX
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Zip | 76133-5649
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Country | US
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Telephone | 682-582-3985
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Fax | 682-224-2997
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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 | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | 20201004P
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State |
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