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NPI Code Detail

MEDICARE: KOESHA PORCHE JACKSON

MEDICARE: KOESHA PORCHE 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
1106E00000XAssistant Behavior AnalystTX

General Provider Information

NPI Number : 1750248662
Entity Type Code : Individual
Provider Name (Legal Business Name) : KOESHA PORCHE JACKSON
Provider Business Mailing Address
First Line : 7108 S KANNER HWY
Second Line :
City : STUART
State : FL
Zip : 34997-7462
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 400 E ROYAL LN
Second Line :
City : IRVING
State : TX
Zip : 75039-3540
Country : US
Telephone Number : 817-242-3733
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2026
Last Update Date : 01/06/2026

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Directions to “ KOESHA PORCHE JACKSON ” Practice Location

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