Demetris Jackson, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MT103613 Issued in TX

Practice address

11777 Katy Fwy Ste 435N
Houston, TX 77079-1703

Phone

(281) 819-3467

NPI assigned

May 3, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Demetris Edwards Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Walker Wellness & Aesthetics Clinic

  dba Walker Wellness & Aesthetic

  • Primary Care Clinic/Center
  • Houston, TX
  • NPI 1003667379

  Massage Therapist

  NPD

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

{
    "created_epoch": "1714694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715904000000",
    "number": "1942057377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10505 TOWN AND COUNTRY WAY UNIT 19175",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "772240110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11777 KATY FWY STE 435N",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770791703",
            "telephone_number": "281-819-3467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DEMETRIS",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-05-03",
        "last_updated": "2024-05-17",
        "certification_date": "2024-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": "TX",
            "license": "MT103613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEMETRIS",
            "last_name": "EDWARDS",
            "credential": "LMT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Courtney Jackson
• Deanna Jackson
• Debra R Jackson, LCSW
• Deidre Co'Llett Jackson, M.ED LPC
• Deja Jackson, BSN, RN
• Denise Mason Jackson
• Deschan Jackson
• Donny G Jackson Jr., RN
• Dorothy Octavia Jackson, PH.D.
• Ebony Chantrice Jackson, CHW INSTRUCTOR

• Massage Therapist in Houston, TX
• Providers in Houston, TX by specialty
• Massage Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2024; 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.