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NPI Code Detail

MEDICARE: DR. SHAWNA LYNN JACKSON AU.D.

MEDICARE: DR. SHAWNA LYNN JACKSON AU.D.
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
1231H00000XAudiologist2010020706MO
2237600000XAudiologist-Hearing Aid Fitter80242TX
3237600000XAudiologist-Hearing Aid Fitter2010020706MO
4231H00000XAudiologist80242TX

General Provider Information

NPI Number : 1104053354
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHAWNA LYNN JACKSON AU.D.
Provider Business Mailing Address
First Line : 1966 INWOOD RD
Second Line :
City : DALLAS
State : TX
Zip : 75235-7298
Country : US
Telephone Number : 972-883-3010
Fax Number : 972-883-3022
Provider Business Practice Location Address
First Line : 700 UNIVERSITY BLVD
Second Line :
City : GALVESTON
State : TX
Zip : 77550-5552
Country : US
Telephone Number : 281-338-0829
Fax Number : 281-557-7284
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2009
Last Update Date : 06/13/2024

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