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Individual
COURTNEY MARIE JACKSON
Active
Individual
COURTNEY MARIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01088399A
IN
207Q00000X
Family Medicine Physician
11021251A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
068010931
MEDICARE PTAN
IN
01
—
266430813
MEDICARE PTAN
—
05
—
300041262
—
IN
Enumeration date
06/17/2020
Last updated
02/02/2026
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