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General NPI Number Information
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NPI Number | 1609300102
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Entity Type | Individual
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Provider Name | ANGEL JACKSON PMHNP
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Gender | Female
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Dates
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Enumeration Date | 04/12/2017
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 5119 BECKWITH BLVD STE 105
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City | SAN ANTONIO
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State | TX
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Zip | 78249-2277
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Country | US
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Telephone | 210-366-3700
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Fax | 210-265-1442
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Provider Business Mailing Address
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Address Line | 911 CENTRAL PKWY N STE 300
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City | SAN ANTONIO
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State | TX
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Zip | 78232-5053
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Country | US
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Telephone | 800-404-6050
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Fax | 866-313-3397
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1024242
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 13441
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License Number State | TX
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