# MS. ATEEYA JACKSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1073279311
- **Gender:** F
- **Credential:** NURSE PRACTITIONER

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WI0500X | Infusion Therapy Registered Nurse | RN623432 | PA | — |
| 363L00000X | Nurse Practitioner | 26NJ1540330 | NJ | Yes |
| 363LF0000X | Family Nurse Practitioner | SP030946 | PA | — |

## Other

- **Enumeration date:** 11/11/2021
- **Last updated:** 10/31/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 6957677 | — | PA |