Provider Demographics
NPI:1831740091
Name:JACKSON, HURU (APRN-BC)
Entity type:Individual
Prefix:
First Name:HURU
Middle Name:
Last Name:JACKSON
Suffix:
Gender:M
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8118 FRY RD STE 201
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-7851
Mailing Address - Country:US
Mailing Address - Phone:832-696-0900
Mailing Address - Fax:
Practice Address - Street 1:8118 FRY RD STE 201
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-7851
Practice Address - Country:US
Practice Address - Phone:832-696-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2023-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143253363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily