Jackson, Mark

Jackson, Mark is an individual health care provider with primary practice located at 6100 Harris Pkwy Ste 1200 , Fort Worth TX 76132-6107. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Jackson, Mark can be contacted via phone (817) 263-3724.

Contact Information

Primary practice address
6100 Harris Pkwy Ste 1200 Fort Worth TX 76132-6107
Phone: (817) 263-3724
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA00410 Texas

Profile Details

NPI number 1922099977
LBN Legal business name Jackson, Mark
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 31st, 2005
Last updated Oct 19th, 2020 - about 6 years 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.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1922099977 NPPES
Texas MEDICAID 285691602
Texas MEDICAID 285691601

Popular Providers