Provider Demographics
NPI:1013155621
Name:JACKSON, FELICIA ANNETTE (RN)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:ANNETTE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17610 DURHAM RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-2986
Mailing Address - Country:US
Mailing Address - Phone:281-973-8212
Mailing Address - Fax:
Practice Address - Street 1:17610 DURHAM RIDGE LN
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-2986
Practice Address - Country:US
Practice Address - Phone:281-973-8212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX741762163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse