Provider Demographics
NPI:1316514896
Name:JACKSON, KELSI JANEE (PHLEBOTOMIST)
Entity type:Individual
Prefix:
First Name:KELSI
Middle Name:JANEE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9219 KENDALE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-8011
Mailing Address - Country:US
Mailing Address - Phone:281-628-4000
Mailing Address - Fax:
Practice Address - Street 1:9219 KENDALE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-8011
Practice Address - Country:US
Practice Address - Phone:281-628-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-04
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20-3297246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy