Provider Demographics
NPI:1851000764
Name:JACKSON, JAMES CAMERON (CSFA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CAMERON
Last Name:JACKSON
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 W STATE HIGHWAY 6 PO BOX 20661
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76702
Mailing Address - Country:US
Mailing Address - Phone:903-944-4646
Mailing Address - Fax:
Practice Address - Street 1:10113 BARTON CREEK DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-5877
Practice Address - Country:US
Practice Address - Phone:903-944-4646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-18
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant