Provider Demographics
NPI:1972300283
Name:JACKSON, LUCRESHIA MONETTE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:LUCRESHIA
Middle Name:MONETTE
Last Name:JACKSON
Suffix:
Gender:
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5007 LEGEND RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441-2339
Mailing Address - Country:US
Mailing Address - Phone:731-803-9097
Mailing Address - Fax:
Practice Address - Street 1:5007 LEGEND RIDGE CT
Practice Address - Street 2:
Practice Address - City:FULSHEAR
Practice Address - State:TX
Practice Address - Zip Code:77441-2339
Practice Address - Country:US
Practice Address - Phone:731-803-9097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN257002163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse