Provider Demographics
NPI:1285235242
Name:JACKSON, AMY FAY (RN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:FAY
Last Name:JACKSON
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:8201 EWING HALSELL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3707
Mailing Address - Country:US
Mailing Address - Phone:210-575-8425
Mailing Address - Fax:210-575-8004
Practice Address - Street 1:8201 EWING HALSELL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3707
Practice Address - Country:US
Practice Address - Phone:210-575-8425
Practice Address - Fax:210-575-8004
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1018934363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily