Provider Demographics
NPI:1801871041
Name:WHITE-JACKSON, SHEILA L (MD)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:L
Last Name:WHITE-JACKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3310 LIVE OAK ST
Practice Address - Street 2:YOUTH AND FAMILY CENTER
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6153
Practice Address - Country:US
Practice Address - Phone:214-266-1257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6982208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139505514Medicaid
TX139505522Medicaid
TX87W595OtherBLUE CROSS BLUE SHIELD
TX139505530Medicaid
TX139505502Medicaid
TX139505508Medicaid
TX139505529Medicaid
TX139505531Medicaid
TX139505501Medicaid
TX139505505Medicaid
TX139505511Medicaid
TX139505516Medicaid
TX139505509Medicaid
TX139505507Medicaid
TX139505523Medicaid
TX139505527Medicaid
TX139505506Medicaid
TX139505525Medicaid
TX139505504Medicaid
TX139505515Medicaid
TX139505517Medicaid
TX139505521Medicaid
TX139505526Medicaid
TX139505528Medicaid
TX139505505Medicaid
TX139505507Medicaid