Provider Demographics
NPI:1982440632
Name:JACKSON, PRISCILLA NICHOLE (IBCLC)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:NICHOLE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3007 WOODLAND HILLS DR # 205
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-1403
Mailing Address - Country:US
Mailing Address - Phone:713-377-8738
Mailing Address - Fax:
Practice Address - Street 1:33300 EGYPT LN STE F400
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-2743
Practice Address - Country:US
Practice Address - Phone:281-305-0411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN