Individual
LISA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PCA
Contact information
Practice address
2423 MONTANA BLUE DR, SPRING, TX 77373-7871
(832) 484-2740
Mailing address
700 SMITH ST # 61070, HOUSTON, TX 77002-7871
(832) 484-2740
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
82-4881025
—
TX
Enumeration date
10/25/2018
Last updated
10/25/2018
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