Provider Demographics
NPI:1033300355
Name:JACKSON, MARY DAWN (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:DAWN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARL R. DARNALL AMC
Mailing Address - Street 2:36000 DARNALL LOOP
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544
Mailing Address - Country:US
Mailing Address - Phone:254-288-2540
Mailing Address - Fax:254-288-8966
Practice Address - Street 1:CARL R. DARNALL AMC
Practice Address - Street 2:36000 DARNALL LOOP
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-288-2540
Practice Address - Fax:254-288-8966
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX719099163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse