Individual
ANGEL JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
5119 BECKWITH BLVD STE 105, SAN ANTONIO, TX 78249-2277
(210) 366-3700
(210) 265-1442
Mailing address
911 CENTRAL PKWY N STE 300, SAN ANTONIO, TX 78232-5053
(800) 404-6050
(866) 313-3397
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
13441
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
1024242
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1024242
TEXAS BOARD OF NURSING
TX
01
—
13441
TEXAS BOARD OF CHIROPRACTIC EXAMINERS
TX
Enumeration date
04/12/2017
Last updated
10/29/2024
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