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Individual
TERRI D. JACKSON
Active
Individual
TERRI D. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00941
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
179959501
—
TX
05
—
179959502
—
TX
01
—
8N4447
BLUE CROSS BLUE SHIELD
TX
01
—
P00051267
RAILROAD MEDICARE
TX
Enumeration date
08/01/2005
Last updated
09/03/2009
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