Individual
DONNA LACHELLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2990 N BROADWAY AVE, TYLER, TX 75702-2149
(903) 535-9041
Mailing address
523 S FANNIN AVE, TYLER, TX 75702-8204
(903) 535-9041
Taxonomy
Speciality
Code
Description
License number
State
163WC1600X
Continuing Education/Staff Development Registered Nurse
676887
TX
363L00000X
Nurse Practitioner
Primary
1032219
TX
Other
Enumeration date
09/04/2020
Last updated
03/27/2024
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