Provider Demographics
NPI:1639980162
Name:JACKSON, MEAGAN GENAI (MBA)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:GENAI
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MBA
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:GENAI
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6766 ANTOINE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77091-1208
Mailing Address - Country:US
Mailing Address - Phone:713-636-9109
Mailing Address - Fax:
Practice Address - Street 1:6766 ANTOINE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77091-1208
Practice Address - Country:US
Practice Address - Phone:713-636-9109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374700000XNursing Service Related ProvidersTechnicianGroup - Single Specialty