Individual
ANGELICA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1616 CLEAR LK CTY BLVD STE 102, HOUSTON, TX 77062-8069
(713) 493-1346
Mailing address
4706 SABERO LN, LEAGUE CITY, TX 77573-4893
(951) 970-7201
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
0010-05899
NC
363AM0700X
Medical Physician Assistant
Primary
PA11392
TX
Other
Enumeration date
08/31/2015
Last updated
04/29/2024
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