Provider Demographics
NPI:1891840567
Name:JACKSON, RONDA L (RNFA)
Entity Type:Individual
Prefix:
First Name:RONDA
Middle Name:L
Last Name:JACKSON
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7706 CREEK WOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-2491
Mailing Address - Country:US
Mailing Address - Phone:214-505-1062
Mailing Address - Fax:
Practice Address - Street 1:1130 BELT LINE RD
Practice Address - Street 2:SUITE 135
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-3665
Practice Address - Country:US
Practice Address - Phone:972-530-9933
Practice Address - Fax:972-530-9004
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX639368163W00000X
TX010309163WX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WX0800XNursing Service ProvidersRegistered NurseOrthopedic