Provider Demographics
NPI:1144918715
Name:JACKSON, SCHWON D (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:SCHWON
Middle Name:D
Last Name:JACKSON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 TIMBERLAND DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-4782
Mailing Address - Country:US
Mailing Address - Phone:903-394-9123
Mailing Address - Fax:
Practice Address - Street 1:1919 TIMBERLAND DR
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75181-4782
Practice Address - Country:US
Practice Address - Phone:903-394-9123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX768215163WC1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development