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NPI Code Detail

MEDICARE: AKINIA MONEE JACKSON

MEDICARE: AKINIA MONEE JACKSON
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
1174400000XSpecialist

General Provider Information

NPI Number : 1477684520
Entity Type Code : Individual
Provider Name (Legal Business Name) : AKINIA MONEE JACKSON
Provider Business Mailing Address
First Line : 12655 CROSSROADS PARK DR
Second Line : #121
City : HOUSTON
State : TX
Zip : 77065-3375
Country : US
Telephone Number : 281-894-2592
Fax Number :
Provider Business Practice Location Address
First Line : 5850 SAN FELIPE ST
Second Line : 500
City : HOUSTON
State : TX
Zip : 77057-3070
Country : US
Telephone Number : 713-706-6180
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2007
Last Update Date : 07/08/2007

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Directions to “ AKINIA MONEE JACKSON ” Practice Location

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