Individual provider · Type 1 NPI
Shauntorya Jackson, AGNP
Gerontology Nurse Practitioner · Flower Mound, TX
NPI number
1104296615
Active
Practice location
2281 Olympia Dr, Suite 100
Flower Mound, TX 75028-1857
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner | 363L00000X | AP128145 (TX) |
| Gerontology Nurse Practitioner Primary | 363LG0600X | AP128145 (TX) |
Gerontology Nurse Practitioner: Definition to come...
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About NPI 1104296615
Shauntorya Jackson, AGNP's National Provider Identifier is 1104296615, issued on Sep 28, 2015. The primary taxonomy on file is Gerontology Nurse Practitioner (363LG0600X), and the practice location is in Flower Mound, TX. The record was last updated on Jul 5, 2023.