Individual
MS. BRANDI JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
910 E HOUSTON ST STE 100, TYLER, TX 75702-8363
(903) 579-9800
(903) 579-9935
Mailing address
910 E HOUSTON ST STE 100, TYLER, TX 75702-8363
(903) 579-9800
(903) 579-9935
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP139346
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
390903801
—
TX
Enumeration date
10/19/2018
Last updated
01/17/2019
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