Individual
KELLY D JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
602 W SEMANDS ST, CONROE, TX 77301-1867
(936) 756-5598
Mailing address
602 W SEMANDS ST, CONROE, TX 77301-1867
(936) 756-5598
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
154385
OH
164X00000X
Licensed Vocational Nurse
Primary
317819
TX
Other
Enumeration date
08/09/2018
Last updated
08/09/2018
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