Individual
KRISTINA GAYLE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
C.R.N.A.
Contact information
Practice address
755 N 11TH ST, SUITE P3600, BEAUMONT, TX 77702-1500
(409) 838-5214
Mailing address
PO BOX 5587, BEAUMONT, TX 77726-5587
(409) 838-5214
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN0000142813
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
APN 15075
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07805512
—
MS
05
—
1521274
—
TN
01
—
1558684183
CHAMPUS/HUMANA TRICARE
TN
01
—
4266382
BLUE CROSS OF TN
TN
01
—
P00907129
RAILROAD MEDICARE
TN
Enumeration date
03/10/2010
Last updated
02/25/2015
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