Individual
KIESHA L JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
101 E PARK BLVD STE 600, PLANO, TX 75074-8818
(469) 864-0497
Mailing address
101 E PARK BLVD STE 600, PLANO, TX 75074-8818
(469) 864-0497
Taxonomy
Speciality
Code
Description
License number
State
171400000X
Health & Wellness Coach
Primary
NA
TX
172V00000X
Community Health Worker
NA
TX
174H00000X
Health Educator
NA
MS
Other
Enumeration date
11/11/2025
Last updated
11/11/2025
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