# AMI RYNAE JACKSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1477820173
- **Gender:** F
- **Credential:** CRNP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WA0400X | Addiction (Substance Use Disorder) Registered Nurse | 0001233148 | VA | — |
| 363LP0200X | Pediatric Nurse Practitioner | AP10123 | LA | Yes |
| 363LP0200X | Pediatric Nurse Practitioner | SP009725 | PA | — |

## Other

- **Enumeration date:** 11/23/2011
- **Last updated:** 04/18/2022