Provider Demographics
NPI:1881464246
Name:JACKSON, LAKIFFANIE PATRYCE (APRN-CNP)
Entity type:Individual
Prefix:
First Name:LAKIFFANIE
Middle Name:PATRYCE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 VERMILLION OAK ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-2050
Mailing Address - Country:US
Mailing Address - Phone:713-315-1048
Mailing Address - Fax:
Practice Address - Street 1:7070 KNIGHTS CT STE 1301
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-5525
Practice Address - Country:US
Practice Address - Phone:713-352-3166
Practice Address - Fax:713-547-4468
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX754934261QX0200X
TX1134383363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology