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General NPI Number Information
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NPI Number | 1679435440
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Entity Type | Individual
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Provider Name | JERRICA A JACKSON
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Gender | Female
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 1333 W MCDERMOTT DR STE 200
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City | ALLEN
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State | TX
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Zip | 75013-3089
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Country | US
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Telephone | 469-767-4958
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Fax |
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Provider Business Mailing Address
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Address Line | 8741 SOMERVILLE WAY
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City | PLANO
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State | TX
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Zip | 75025-4185
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Country | US
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Telephone | 469-288-5069
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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