Provider Demographics
NPI:1598044687
Name:JACKSON, SHERYL SWOOPES
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:SWOOPES
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHERYL
Other - Middle Name:SWOOPES
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8106 LAKE EDGE CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-3630
Mailing Address - Country:US
Mailing Address - Phone:713-773-4687
Mailing Address - Fax:713-773-1687
Practice Address - Street 1:10764 S GESSNER DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77071-3509
Practice Address - Country:US
Practice Address - Phone:713-773-4687
Practice Address - Fax:713-773-1687
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000558332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies