Active NPI
Candice Jackson
- Administrator Registered Nurse
- Richmond, TX
National Provider Identifier
1174778393
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Administrator Registered Nurse
- License
- 009445
- Practice address
- 1235 Blue Leaf Dr
Richmond, TX 77469-6255 - Phone
- (281) 793-2734
- Fax
- (281) 754-4393
- NPI assigned
- Dec 2, 2008
- Last updated
- Dec 9, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Administrator Registered Nurse | 163WA2000X | 009445 | TX | Primary |
Addresses
Primary practice location
1235 Blue Leaf Dr
Richmond, TX 77469-6255
Mailing address
PO Box 701
Richmond, TX 77406-0018
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 009445 | TX | MD | Administrator Registered Nurse |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1228176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1228780800000",
"number": "1174778393",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 701",
"city": "RICHMOND",
"state": "TX",
"postal_code": "774060018"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1235 BLUE LEAF DR",
"city": "RICHMOND",
"state": "TX",
"postal_code": "774696255",
"telephone_number": "281-793-2734",
"fax_number": "281-754-4393"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "CANDICE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-12-02",
"last_updated": "2008-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "163WA2000X",
"taxonomy_group": "",
"desc": "Registered Nurse, Administrator",
"state": "TX",
"license": "009445",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richmond, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.