Organization
LEE JACKSON ENTERPRISES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NIKIA AUTRY NIKIA A AUTRY (MANAGING MEMBER)
(866) 301-1456
Entity
Organization
Contact information
Practice address
3626 N HALL ST STE 610, DALLAS, TX 75219-5131
(866) 301-1456
(469) 898-6344
Mailing address
3626 N HALL ST STE 610, DALLAS, TX 75219-5131
(866) 301-1456
(469) 898-6344
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
—
—
224900000X
Mastectomy Fitter
—
—
246RP1900X
Phlebotomy Technician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
08/17/2022
Last updated
10/22/2024
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