Provider Demographics
NPI:1245942655
Name:JACKSON, BRITNEY (FNT, ANT)
Entity type:Individual
Prefix:
First Name:BRITNEY
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:FNT, ANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4008 LOUETTA RD # 240
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-4405
Mailing Address - Country:US
Mailing Address - Phone:346-704-2215
Mailing Address - Fax:
Practice Address - Street 1:16630 IMPERIAL VALLEY DR STE 118
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-3410
Practice Address - Country:US
Practice Address - Phone:346-704-2215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes211D00000XPodiatric Medicine & Surgery Service ProvidersAssistant, PodiatricGroup - Single Specialty