Individual
CODY BLAKE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
12704 BAMMEL NORTH HOUSTON ROAD, HOUSTON, TX 77066-7706
(713) 461-2915
Mailing address
12704 BAMMEL NORTH HOUSTON RD, HOUSTON, TX 77066-4001
(318) 235-4015
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1073192530
TX
Other
Enumeration date
04/03/2021
Last updated
08/28/2022
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