Individual
JESSICA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1600 11TH ST, WICHITA FALLS, TX 76301-4300
(800) 939-7440
Mailing address
PO BOX 5188, LONGVIEW, TX 75608-5188
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP130093
TX
Other
Enumeration date
01/25/2016
Last updated
01/25/2016
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