Provider Demographics
NPI:1144906355
Name:JACKSON, LESLIE (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E TAYLOR ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-2832
Mailing Address - Country:US
Mailing Address - Phone:903-257-3929
Mailing Address - Fax:
Practice Address - Street 1:600 E TAYLOR ST STE 201
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2832
Practice Address - Country:US
Practice Address - Phone:903-257-3929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1126719363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily