Provider Demographics
NPI:1982280137
Name:JACKSON, DONNY G JR (RN)
Entity Type:Individual
Prefix:MR
First Name:DONNY
Middle Name:G
Last Name:JACKSON
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9346 CANADY PARK LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77075-4084
Mailing Address - Country:US
Mailing Address - Phone:832-443-6778
Mailing Address - Fax:
Practice Address - Street 1:9346 CANADY PARK LN # A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77075-4084
Practice Address - Country:US
Practice Address - Phone:832-443-6778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX707118163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse