Provider Demographics
NPI:1972921500
Name:JACKSON, CHRISTINE S (NP-C)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:S
Last Name:JACKSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2693 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1624
Mailing Address - Country:US
Mailing Address - Phone:409-832-8862
Mailing Address - Fax:409-832-1664
Practice Address - Street 1:2693 NORTH ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1624
Practice Address - Country:US
Practice Address - Phone:409-832-8862
Practice Address - Fax:409-832-1664
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125323363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX353166701Medicaid