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NPI Code Detail

MEDICARE: KAYLA JACKSON

MEDICARE: KAYLA 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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1912683590
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAYLA JACKSON
Provider Business Mailing Address
First Line : 6455 S SHORE BLVD
Second Line :
City : LEAGUE CITY
State : TX
Zip : 77573-5523
Country : US
Telephone Number : 832-932-9364
Fax Number :
Provider Business Practice Location Address
First Line : 6455 S SHORE BLVD
Second Line :
City : LEAGUE CITY
State : TX
Zip : 77573-5523
Country : US
Telephone Number : 832-932-9364
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2023
Last Update Date : 06/27/2023

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Directions to “ KAYLA JACKSON ” Practice Location

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