Individual
KEVIN JACKSON SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
6606 LBJ FWY, SUITE 200, DALLAS, TX 75240-6533
(972) 715-5000
(972) 715-9976
Mailing address
PO BOX 650865, DALLAS, TX 75265-0865
(972) 715-5000
(972) 715-1996
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP132899
TX
390200000X
Student in an Organized Health Care Education/Training Program
862974
TX
Other
Enumeration date
08/18/2016
Last updated
01/05/2017
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