Individual
JONATHAN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LVN
Contact information
Practice address
8700 CROWNHILL BLVD, SAN ANTONIO, TX 78209-1136
(210) 860-5027
Mailing address
8700 CROWNHILL BLVD, SAN ANTONIO, TX 78209-1136
(210) 860-5027
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
352554
TX
Other
Enumeration date
04/15/2020
Last updated
04/15/2020
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