| NPI | 1427594381 |
|---|---|
| Former Name | KATRINA JADE JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA11078) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX PA11078) |
| Enumeration Date | 2017-01-16 |
| Last Update Date | 2024-07-23 |