Individual
ALLISON NICOLE JACKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
4750 FM 1196, SAN AUGUSTINE, TX 75972-5433
(936) 201-3374
Mailing address
755 S BECKHAM AVE, TYLER, TX 75701-1903
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
341533
TX
Other
Enumeration date
01/22/2020
Last updated
01/22/2020
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