Active NPI
Paul Jackson
- Adult Companion
- Garland, TX
National Provider Identifier
1639435019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Companion
- Practice address
- 2229 Pueblo Dr
Garland, TX 75040-4328 - Phone
- (214) 734-8394
- Fax
- (972) 414-1261
- NPI assigned
- Apr 10, 2012
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Adult Companion | 372600000X | Primary |
Addresses
Primary practice location
2229 Pueblo Dr
Garland, TX 75040-4328
Mailing address
2229 Pueblo Dr
Garland, TX 75040-4328
Phone (214) 734-8394
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1334016000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1334016000000",
"number": "1639435019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2229 PUEBLO DR",
"city": "GARLAND",
"state": "TX",
"postal_code": "750404328",
"telephone_number": "214-734-8394",
"fax_number": "972-414-1261"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2229 PUEBLO DR",
"city": "GARLAND",
"state": "TX",
"postal_code": "750404328",
"telephone_number": "214-734-8394",
"fax_number": "972-414-1261"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "PAUL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-04-10",
"last_updated": "2012-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "372600000X",
"taxonomy_group": "",
"desc": "Adult Companion",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Garland, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.