Cody Blake Jackson, FNP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

1073192530 Issued in TX

Practice address

12704 Bammel North Houston Road
Houston, TX 77066-7706

Phone

(713) 461-2915

NPI assigned

Apr 3, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Interoperability endpoints

• Direct secure messaging: cody.jackson.1@30127.direct.athenahealth.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1617408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661644800000",
    "number": "1073192530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12704 BAMMEL NORTH HOUSTON RD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770664001",
            "telephone_number": "318-235-4015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12704 BAMMEL NORTH HOUSTON ROAD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770667706",
            "telephone_number": "713-461-2915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CODY",
        "middle_name": "BLAKE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-03",
        "last_updated": "2022-08-28",
        "certification_date": "2022-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "1073192530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carla Renee Jackson
• Charlotte Lynetta Jackson
• Cheyenne Jackson, MS
• Chrystal Jackson
• Clifford Jackson III
• Constance A. Jackson, LPC
• Courtney Jackson
• Deanna Jackson
• Debra R Jackson, LCSW
• Deidre Co'Llett Jackson, M.ED LPC

• Nurse Practitioner in Houston, TX
• Providers in Houston, TX by specialty
• Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.