Individual
CANDICE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1235 BLUE LEAF DR, RICHMOND, TX 77469-6255
(281) 793-2734
(281) 754-4393
Mailing address
PO BOX 701, RICHMOND, TX 77406-0018
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
009445
TX
Other
Enumeration date
12/02/2008
Last updated
12/09/2008
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