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NPI Code Detail

MEDICARE: CHRISTINE S JACKSON NP-C

MEDICARE: CHRISTINE S JACKSON NP-C
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 PractitionerAP125323TX

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 : 1972921500
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINE S JACKSON NP-C
Provider Business Mailing Address
First Line : 2693 NORTH ST
Second Line :
City : BEAUMONT
State : TX
Zip : 77702-1624
Country : US
Telephone Number : 409-832-8862
Fax Number : 409-832-1664
Provider Business Practice Location Address
First Line : 2693 NORTH ST
Second Line :
City : BEAUMONT
State : TX
Zip : 77702-1624
Country : US
Telephone Number : 409-832-8862
Fax Number : 409-832-1664
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2014
Last Update Date : 12/14/2023

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Directions to “ CHRISTINE S JACKSON NP-C” Practice Location

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