Provider Demographics
NPI:1679117063
Name:NJERU, JACKSON NGIGI (PMHNP-BC, PHD)
Entity Type:Individual
Prefix:DR
First Name:JACKSON
Middle Name:NGIGI
Last Name:NJERU
Suffix:
Gender:M
Credentials:PMHNP-BC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 TOUCAN DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-8547
Mailing Address - Country:US
Mailing Address - Phone:214-491-7440
Mailing Address - Fax:
Practice Address - Street 1:1425 TOUCAN DR
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-8547
Practice Address - Country:US
Practice Address - Phone:214-491-7440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXXXXXXXXX363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty