MEDICARE: DR. LINDSEY NICOLE JACKSON MD, PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	N0125	TX
2	208D00000X	General Practice Physician	N0125	TX
3	204R00000X	Electrodiagnostic Medicine Physician	N0125	TX

General Provider Information

NPI Number	:	1013111681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDSEY NICOLE JACKSON MD, PHD

Provider Business Mailing Address
First Line	:	308 E EDGEWOOD DR
Second Line	:
City	:	FRIENDSWOOD
State	:	TX
Zip	:	77546-3823
Country	:	US
Telephone Number	:	281-992-4495
Fax Number	:	281-992-7412

Provider Business Practice Location Address
First Line	:	12337 JONES RD STE 427
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-4951
Country	:	US
Telephone Number	:	832-912-8603
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	03/05/2012

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