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Individual
MS. PAMELA KAROL JACKSON
Active
Individual
MS. PAMELA KAROL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
530242
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
141129002
—
TX
01
—
500026894
RAILROAD MEDICARE
TX
01
—
89N835
BLUECROSS BLUE SHIELD TX
TX
Enumeration date
09/20/2006
Last updated
10/06/2016
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