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General NPI Number Information
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NPI Number | 1962688093
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Entity Type | Individual
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Provider Name | RHONDA LEE JACKMAN CPNP
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Gender | Female
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Dates
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Enumeration Date | 01/18/2008
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Last Update Date | 11/30/2009
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Provider Practice Location Address
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Address Line | 9101 N CENTRAL EXPY STE 420
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City | DALLAS
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State | TX
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Zip | 75231-5945
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Country | US
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Telephone | 214-823-2525
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Fax |
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Provider Business Mailing Address
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Address Line | 1317 STONY BROOK LN
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City | GARLAND
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State | TX
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Zip | 75043-1342
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Country | US
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Telephone | 972-926-9373
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 535375
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License Number State | TX
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