STACEY RENEE JACKSON NP NPI 1669828224

NPI Information

NPI: 1669828224
Provider Name: STACEY RENEE JACKSON, NP
Classification: Nurse Practitioner - 363LA2100X
Entity Type: Individual

Specialization: Acute Care

PECOS Registration: Yes

Address:
906 W RANDOL MILL RD
ARLINGTON, TX
ZIP 76012
Phone: (817) 261-4906
Get Directions

Stacey Renee Jackson, NP is an acute care nurse practitioner in Arlington, TX. Stacey Renee Jackson, NP NPI is 1669828224. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

906 W RANDOL MILL RD
ARLINGTON, TX
ZIP 76012-510
Phone: (817) 261-4906
Fax: (817) 261-5837

The NPI 1669828224 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 5/12/2016 and was last updated on 7/22/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LA2100X	Nurse Practitioner	Acute Care	AP130643	TEXAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	509731YKQL	MEDICARE PIN	TEXAS
2	509731YKPW	MEDICARE PIN	TEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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