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NPI Code Detail

MEDICARE: MS. BRANDI JACKSON FNP

MEDICARE: MS. BRANDI JACKSON FNP
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
1363LF0000XFamily Nurse PractitionerAP139346TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356817050
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BRANDI JACKSON FNP
Provider Business Mailing Address
First Line : 910 E HOUSTON ST STE 100
Second Line :
City : TYLER
State : TX
Zip : 75702-8363
Country : US
Telephone Number : 903-579-9800
Fax Number : 903-579-9935
Provider Business Practice Location Address
First Line : 910 E HOUSTON ST STE 100
Second Line :
City : TYLER
State : TX
Zip : 75702-8363
Country : US
Telephone Number : 903-579-9800
Fax Number : 903-579-9935
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2018
Last Update Date : 01/17/2019

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Directions to “ MS. BRANDI JACKSON FNP” Practice Location

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