Antonious Dewayne Jackson, D.C., F.N.P-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP133741 Issued in TX

Practice address

2900 Highway 121 Ste 120
Bedford, TX 76021-4033

Phone

(817) 921-3000

Fax

(817) 921-3001

NPI assigned

May 29, 2007

Last updated

Apr 12, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1180396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491955200000",
    "number": "1205037322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 627",
            "city": "HURST",
            "state": "TX",
            "postal_code": "760530627",
            "telephone_number": "817-770-3565",
            "fax_number": "817-921-3001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 HIGHWAY 121 STE 120",
            "city": "BEDFORD",
            "state": "TX",
            "postal_code": "760214033",
            "telephone_number": "817-921-3000",
            "fax_number": "817-921-3001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ANTONIOUS",
        "middle_name": "DEWAYNE",
        "credential": "D.C., F.N.P-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-29",
        "last_updated": "2017-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP133741",
            "primary": true
        },
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "TX",
            "license": "DC9074",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ehiremen Martins Iyoha, MD
• J. D. Bell, M.D., P.a.
• Ommara Shereen Jabbar, MD
• Jack Jones Hearing Centers, Inc. (AudioNova)
• Mahalia L Jackson-Butler, DNP, APRN
• Ryan C Jackson, MD
• Sharon L Jackson, MD
• Stacey Jackson, FNP-C
• Tinu Elsa Jacob, RPH
• Janus Long Jacobs, FNP

• Family Nurse Practitioner in Bedford, TX
• Providers in Bedford, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2017; 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.