Provider Demographics
NPI:1447041520
Name:JACKSON, JENISE T (PHLEBOTOMIST)
Entity type:Individual
Prefix:
First Name:JENISE
Middle Name:T
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6325 ELEPHANT BUTTE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-7509
Mailing Address - Country:US
Mailing Address - Phone:254-245-1208
Mailing Address - Fax:254-245-1208
Practice Address - Street 1:6325 ELEPHANT BUTTE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-7509
Practice Address - Country:US
Practice Address - Phone:254-245-1208
Practice Address - Fax:254-245-1208
Is Sole Proprietor?:No
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246R00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Pathology
No246Q00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Pathology