Provider Demographics
NPI:1700313566
Name:WARREN-JACKSON, JACKIE YVETTE (FNP)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:YVETTE
Last Name:WARREN-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 1:7726 POITIERS DR.
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071
Mailing Address - Country:US
Mailing Address - Phone:832-439-9062
Mailing Address - Fax:
Practice Address - Street 1:7447 HARWIN DR. STE 109
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036
Practice Address - Country:US
Practice Address - Phone:832-251-6524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131783363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily