Provider Demographics
NPI:1982413688
Name:JACKSON, ASHLI BROOKE (RN)
Entity type:Individual
Prefix:MISS
First Name:ASHLI
Middle Name:BROOKE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8425 BELLCHASE DR APT 1412
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76120-4924
Mailing Address - Country:US
Mailing Address - Phone:940-902-1436
Mailing Address - Fax:
Practice Address - Street 1:8425 BELLCHASE DR APT 1412
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76120-4924
Practice Address - Country:US
Practice Address - Phone:940-902-1436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1101767163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse