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General NPI Number Information
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NPI Number | 1992151104
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Entity Type | Individual
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Provider Name | JOHNATHAN STEPHEN JACKSON DNP, FNP-C, PMHNP-C
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Gender | Male
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Dates
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Enumeration Date | 05/05/2016
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Last Update Date | 04/10/2026
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Provider Practice Location Address
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Address Line | 4100 SPRING VALLEY RD STE 910
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City | FARMERS BRANCH
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State | TX
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Zip | 75244-3646
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Country | US
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Telephone | 469-474-5397
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Fax |
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Provider Business Mailing Address
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Address Line | 4100 SPRING VALLEY RD STE 910
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City | FARMERS BRANCH
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State | TX
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Zip | 75244-3646
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Country | US
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Telephone | 940-290-7592
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP130946
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP130946
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License Number State | TX
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