HOLLY JACKSON (NPI# 1467826248) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1467826248 |
Entity Type | Individual |
Full Name | HOLLY JACKSON |
Other Name | HOLLY KOONCE |
Credential | PA-C |
Practice Address |
4421 Highway 6 S Ste 100 College Station TX 77845-6176 |
Mailing Address |
805 Hill Blvd Unit 104 Granbury TX 76048-1482 |
Practice Telephone | 9797315200 |
Practice Fax Number | 9797315210 |
Mailing Telephone | 8175735760 |
Enumeration Date | 2015-11-17 |
Last Update Date | 2018-11-28 |
Gender Code | F |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363A00000X | Physician Assistant | PA10119 | TX | Physician Assistants & Advanced Practice Nursing Providers |
Address | Telephone Number | Fax Number |
---|---|---|
805 Hill Blvd Unit 104, Granbury, TX 760481482 | 8175735760 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1689275802 | Holly Marie Jackson | Technician | 448 W Cooper St, Tipton, MO 65081-8217 | 2020-11-04 |
1689156721 | Holly Alegro Jackson | Non-emergency Medical Transport (VAN) | 10550 Murat Dr, Saint Louis, MO 63136-4524 | 2018-09-05 |
1417351453 | Holly Jean Jackson | Licensed Practical Nurse | 5a Lafayette Avenue, Canandaigua, NY 14424 | 2014-10-20 |
1013212711 | Holly Jackson | Social Worker | 511 W 86th Ter, Kansas City, MO 64114-2822 | 2011-01-11 |
1083882278 | Holly Jackson | Licensed Practical Nurse | 2040 Murray Holladay Rd Ste 205, Salt Lake City, UT 84117-5197 | 2008-02-11 |
1548753700 | Holly Jean Jackson | Behavior Technician | 19800 Village Office Ct, Bend, OR 97702-1872 | 2018-06-12 |
1922596220 | Holly Suzanne Jackson | Counselor | 1100 Walnut St, Owensboro, KY 42301-2956 | 2018-04-23 |
1720575392 | Holly Jackson | Nurse Anesthetist, Certified Registered | 7601 Southcrest Pkwy, Southaven, MS 38671-4739 | 2018-04-18 |
1427576511 | Holly M Jackson | Nurse Practitioner | 905 Dixie St, Carrollton, GA 30117-4417 | 2017-09-08 |
1427597301 | Holly Jackson | Registered Nurse | 1109 Jones St, Kennett, MO 63857-3824 | 2017-02-13 |
Street Address |
4421 HIGHWAY 6 S STE 100 |
City | COLLEGE STATION |
State | TX |
Zip Code | 77845-6176 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1104874809 | Janet Krueger | Emergency Medicine | 4421 Highway 6 S Ste 100, College Station, TX 77845-6176 | 2006-05-04 |
1366930174 | Kelli Rich | Nurse Practitioner | 4421 Highway 6 S Ste 100, College Station, TX 77845-6176 | 2018-04-26 |
1396126116 | Jana Kimberlin | Nurse Practitioner | 4421 Highway 6 S Ste 100, College Station, TX 77845-6176 | 2015-06-17 |
1740445758 | Mario Rizalino Bascon Roa Jr. | Family Medicine | 4421 Highway 6 S Ste 100, College Station, TX 77845-6176 | 2008-07-20 |
1982724134 | Richard Lawrence Delezene | Physician Assistant | 4421 Highway 6 S Ste 100, College Station, TX 77845-6176 | 2007-03-30 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1518503101 | Aggieland Urgent Care Pllc | Clinic/Center | 13055 Fm 2154 Rd, College Station, TX 77845 | 2019-11-19 |
1770053399 | Alyssa Nicole Sanchez | Licensed Vocational Nurse | 4030 Hwy 6 S 150, College Station, TX 77845 | 2018-11-27 |
1154805778 | Medical Care Innovation, P.C. | Clinic/Center | 200 Quality Circle, College Station, TX 77845 | 2018-09-19 |
1003302530 | Kaye Lynn Tseng | Registered Nurse | 4030 Hightway 6 South, College Station, TX 77845 | 2018-07-09 |
1083117907 | College Station Dentistry and Orthodontics Pllc | Dentist | 11671 Fm 2154, Suite 400, College Station, TX 77845 | 2018-03-16 |
1912409954 | H-e-b, Lp | Clinical Medical Laboratory | 11675 Fm 2154, College Station, TX 77845 | 2018-03-06 |
1871095745 | Gregory Nicholas Perry | Physical Therapist | 4091 Sh 6 South, Suite B, College Station, TX 77845 | 2018-03-06 |
1811435639 | Michael Patke | Student in an Organized Health Care Education/Training Program | 10613 Deer Run Dr., College Station, TX 77845 | 2017-02-01 |
1558810473 | Sara Beth Williamson | Nurse Practitioner | 4401 State Hwy 6 S, College Station, TX 77845 | 2016-10-04 |
1881067379 | Kieshia Lewis | Occupational Therapy Assistant | 2700 Earl Rudder Frwy Suite 1200, College Station, TX 77845 | 2015-11-05 |
Find all providers in zip 77845 |
Taxonomy Code | 363A00000X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1174591242 | Jon C Teacle | Physician Assistant | 2803 Earl Rudder Fwy S Ste 103, College Station, TX 77845-6099 | 2006-03-14 |
1396305306 | Gerald Darling IIi | Physician Assistant | 2911 Texas Ave S Ste 103, College Station, TX 77845-5388 | 2019-06-20 |
1811491038 | Brittney A Pohler | Physician Assistant | 800 Scott and White Dr, College Station, TX 77845-6440 | 2018-03-21 |
1982107504 | Genevieve Lois Gourlay | Physician Assistant | 700 Scott and White Dr, College Station, TX 77845-6441 | 2018-03-09 |
1255790366 | Porscha Buck | Physician Assistant | 800 Scott and White Dr, College Station, TX 77845-6440 | 2016-02-17 |
1427421270 | Shannon Easterling | Physician Assistant | 800 Scott and White Dr, College Station, TX 77845-6440 | 2015-11-02 |
1316333149 | Claudia Cantu | Physician Assistant | 1264 Tamu, College Station, TX 77843-0001 | 2015-04-08 |
1003204355 | Brittany Rae Rhinehart | Physician Assistant | 700 Scott and White Dr, College Station, TX 77845-6441 | 2015-01-08 |
1841613817 | Amanda Campbell Johnston | Physician Assistant | 700 Scott and White Dr, College Station, TX 77845-6441 | 2014-01-28 |
1174955751 | Haley Allison Jeffrey | Physician Assistant | 1700 University Dr E, College Station, TX 77840-2661 | 2013-08-06 |
Find all providers in COLLEGE STATION |
City | COLLEGE STATION |
Zip Code | 77845 |
Please comment or provide details below to improve the information on HOLLY JACKSON.
Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.