Jackson, Detra L

Jackson, Detra L is an individual health care provider with primary practice located at 1910 Pacific Ave Ste 20001046 , Dallas TX 75201-4529. She recently has 6 registered licenses in different health care specialties including Other Service Providers / Driver, Agencies / Community/Behavioral Health, Nursing & Custodial Care Facilities / Adult Care Home, Nursing & Custodial Care Facilities / Intermediate Care Facility, Mentally Retarded, Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Illness, Other Service Providers / Community Health Worker. Other Service Providers / Community Health Worker is her primary health care specialty. Jackson, Detra L can be contacted via phone (305) 988-7335.

Contact Information

Primary practice address
1910 Pacific Ave Ste 20001046 Dallas TX 75201-4529
Phone: (305) 988-7335
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Driver 172A00000X
Agencies / Community/Behavioral Health 251S00000X
Nursing & Custodial Care Facilities / Adult Care Home 311ZA0620X
Nursing & Custodial Care Facilities / Intermediate Care Facility, Mentally Retarded 315P00000X
Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Illness 320800000X
Other Service Providers / Community Health Worker 172V00000X

Profile Details

NPI number 1558206359
LBN Legal business name Jackson, Detra L
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 20th, 2026
Last updated Apr 20th, 2026 - about 6 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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