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NPI Code Detail

MEDICARE: MARY KATHLEEN JACKSON

MEDICARE: MARY KATHLEEN 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
1207V00000XObstetrics & Gynecology PhysicianP6191TX

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 : 1558595371
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY KATHLEEN JACKSON
Provider Business Mailing Address
First Line : 23802 HIGHWAY 59 N
Second Line :
City : KINGWOOD
State : TX
Zip : 77339-1510
Country : US
Telephone Number : 281-312-5465
Fax Number : 281-312-5440
Provider Business Practice Location Address
First Line : 23802 HIGHWAY 59 N
Second Line :
City : KINGWOOD
State : TX
Zip : 77339-1510
Country : US
Telephone Number : 281-312-5400
Fax Number : 281-312-5440
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2009
Last Update Date : 04/21/2014

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