Provider Demographics
NPI:1619868098
Name:JACKSON, CECILIA
Entity type:Individual
Prefix:MS
First Name:CECILIA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25722 KINGSLAND BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-2643
Mailing Address - Country:US
Mailing Address - Phone:346-387-8002
Mailing Address - Fax:
Practice Address - Street 1:25722 KINGSLAND BLVD STE 206
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-2643
Practice Address - Country:US
Practice Address - Phone:346-387-8002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX022547163WH0200X, 163WI0500X, 163WW0000X, 253Z00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No253Z00000XAgenciesIn Home Supportive Care