Provider Demographics
NPI:1366815516
Name:JOHNSON-JACKSON, MEGAN (CERTIFIED HAIR LOSS)
Entity type:Individual
Prefix:PROF
First Name:MEGAN
Middle Name:
Last Name:JOHNSON-JACKSON
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8018 NEW WORLD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78239-3517
Mailing Address - Country:US
Mailing Address - Phone:469-712-4526
Mailing Address - Fax:
Practice Address - Street 1:8018 NEW WORLD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78239-3517
Practice Address - Country:US
Practice Address - Phone:469-712-4526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-10
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14435031744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1744P3200XOtherCRANIAL PROTHESIS