Provider Demographics
NPI:1679285258
Name:JACKSON, SHAMEKA
Entity type:Individual
Prefix:
First Name:SHAMEKA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25722 KINGSLAND BLVD STE 115
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-3701
Mailing Address - Country:US
Mailing Address - Phone:832-678-4924
Mailing Address - Fax:
Practice Address - Street 1:25722 KINGSLAND BLVD STE 115
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-3701
Practice Address - Country:US
Practice Address - Phone:832-678-4924
Practice Address - Fax:832-678-4924
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2025-08-20
Deactivation Date:2022-12-15
Deactivation Code:
Reactivation Date:2025-08-20
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No2278H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedHome Health
No376K00000XNursing Service Related ProvidersNurse's Aide