Provider Demographics
NPI:1013111681
Name:JACKSON, LINDSEY NICOLE (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:NICOLE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 E EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-3823
Mailing Address - Country:US
Mailing Address - Phone:281-992-4495
Mailing Address - Fax:281-992-7412
Practice Address - Street 1:12337 JONES RD STE 427
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4951
Practice Address - Country:US
Practice Address - Phone:832-912-8603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0125207P00000X, 208D00000X, 204R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic Medicine