Provider Demographics
NPI:1063110849
Name:JACKSON, HELEN (AGACNP)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 NIGHT OWL CT
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385-3842
Mailing Address - Country:US
Mailing Address - Phone:346-414-2190
Mailing Address - Fax:
Practice Address - Street 1:18980 N MEMORIAL DR STE 280
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4498
Practice Address - Country:US
Practice Address - Phone:713-486-8180
Practice Address - Fax:713-486-8190
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1111268363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care