Provider Demographics
NPI:1922042951
Name:JACKSON, BRENDA D (MSN ACNP-BC)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:D
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MSN ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2432
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75091-2432
Mailing Address - Country:US
Mailing Address - Phone:903-893-5177
Mailing Address - Fax:903-813-0210
Practice Address - Street 1:600 E TAYLOR ST
Practice Address - Street 2:SUITE 3011
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2881
Practice Address - Country:US
Practice Address - Phone:903-893-5177
Practice Address - Fax:903-813-0210
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX257405363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N7563OtherBCBS
TXP00264932OtherRR MEDICARE
TX1744534-01Medicaid
TX1744534-01Medicaid
TX8D5411Medicare ID - Type UnspecifiedMEDICARE