Individual
MRS. SHAUNTORYA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP
Contact information
Practice address
2281 OLYMPIA DR, SUITE 100, FLOWER MOUND, TX 75028-1857
(469) 322-0089
Mailing address
2281 OLYMPIA DR, SUITE 100, FLOWER MOUND, TX 75028-1857
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
AP128145
TX
363LG0600X
Gerontology Nurse Practitioner
Primary
AP128145
TX
Other
Enumeration date
09/28/2015
Last updated
07/05/2023
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