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General NPI Number Information
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NPI Number | 1619868098
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Entity Type | Individual
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Provider Name | MS. CECILIA JACKSON
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Gender | Female
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Dates
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Enumeration Date | 07/14/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 25722 KINGSLAND BLVD STE 206
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City | KATY
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State | TX
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Zip | 77494-2643
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Country | US
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Telephone | 346-387-8002
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Fax |
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Provider Business Mailing Address
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Address Line | 25722 KINGSLAND BLVD STE 206
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City | KATY
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State | TX
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Zip | 77494-2643
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Country | US
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Telephone | 346-387-8002
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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 | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | 022547
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 022547
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 163WI0500X
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Taxonomy Name | Infusion Therapy Registered Nurse
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License Number | 022547
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number | 022547
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 022547
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License Number State | TX
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