Provider Demographics
NPI:1669868113
Name:JACKSON, LEVONIKA (NP)
Entity type:Individual
Prefix:
First Name:LEVONIKA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4855 RIVERSTONE BLVD
Mailing Address - Street 2:103
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4377
Mailing Address - Country:US
Mailing Address - Phone:281-313-6348
Mailing Address - Fax:281-313-6349
Practice Address - Street 1:4855 RIVERSTONE BLVD
Practice Address - Street 2:103
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4377
Practice Address - Country:US
Practice Address - Phone:281-313-6348
Practice Address - Fax:281-313-6349
Is Sole Proprietor?:No
Enumeration Date:2015-04-11
Last Update Date:2015-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP127933363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH33796Medicare UPIN
TX00510VMedicare PIN