Individual
LARA LYNN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
5323 HARRY HINES BOULEVARD, DALLAS, TX 75390-7208
(214) 648-3916
(214) 648-8423
Mailing address
P.O. BOX 845347, DALLAS, TX 75284-5347
(214) 648-3916
(214) 648-8423
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
712187
TX
363L00000X
Nurse Practitioner
Primary
AP120420
TX
363LF0000X
Family Nurse Practitioner
F0611206
TX
Other
Enumeration date
06/17/2011
Last updated
12/13/2016
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