Provider Demographics
NPI:1720557671
Name:JACKSON, JANECIA SONYELL (FNP-C)
Entity Type:Individual
Prefix:
First Name:JANECIA
Middle Name:SONYELL
Last Name:JACKSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2709
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75606-2709
Mailing Address - Country:US
Mailing Address - Phone:903-212-7800
Mailing Address - Fax:903-212-7899
Practice Address - Street 1:1300 N 6TH ST STE A
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5567
Practice Address - Country:US
Practice Address - Phone:903-232-1785
Practice Address - Fax:903-232-1782
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139351363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily