Provider Demographics
NPI:1013167477
Name:JACKSON, LEA ANN (FNP)
Entity Type:Individual
Prefix:MS
First Name:LEA ANN
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3307 SPRING STUEBNER STE. A1
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389
Mailing Address - Country:US
Mailing Address - Phone:281-528-2273
Mailing Address - Fax:281-528-6283
Practice Address - Street 1:3307 SPRING STUEBNER STE. A1
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77389
Practice Address - Country:US
Practice Address - Phone:281-528-2273
Practice Address - Fax:281-528-6283
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP19344363LF0000X
TX707116363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily