Provider Demographics
NPI:1639041197
Name:JACKSON5 HEALTH PLLC
Entity type:Organization
Organization Name:JACKSON5 HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:936-585-2516
Mailing Address - Street 1:109 WOODRUFF LN
Mailing Address - Street 2:
Mailing Address - City:SAN AUGUSTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75972-2637
Mailing Address - Country:US
Mailing Address - Phone:936-955-5540
Mailing Address - Fax:936-955-5541
Practice Address - Street 1:9423 S US HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:TX
Practice Address - Zip Code:75949-1515
Practice Address - Country:US
Practice Address - Phone:936-955-5541
Practice Address - Fax:936-955-5540
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXAS TONE DERMATOLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty