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General NPI Number Information
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NPI Number | 1558782920
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Entity Type | Individual
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Provider Name | MICHELE MARIE JACKSON FNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/02/2014
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Last Update Date | 11/08/2018
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Provider Practice Location Address
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Address Line | 801 W 1ST ST
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City | SAN JUAN
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State | TX
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Zip | 78589
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Country | US
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Telephone | 956-787-8915
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Fax | 956-787-2021
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Provider Business Mailing Address
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Address Line | 515 N KING ST SUITE 103
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City | SEGUIN
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State | TX
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Zip | 78155-4801
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Country | US
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Telephone | 830-372-5200
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Fax | 830-372-5202
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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 | 753035
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License Number State | TX
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