Provider Demographics
NPI:1679162689
Name:JACKSON, ALEXANDRIA JANESE (MSN, APRN, NP)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:JANESE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MSN, APRN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 FM1960 W.
Mailing Address - Street 2:SUITE A-4, #136
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065
Mailing Address - Country:US
Mailing Address - Phone:713-304-1315
Mailing Address - Fax:
Practice Address - Street 1:5718 WESTHEIMER
Practice Address - Street 2:SUITE 1000
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057
Practice Address - Country:US
Practice Address - Phone:713-331-9433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1023085363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty