# BOBBIE JACKSON

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

## Provider details

- **NPI number:** 1568055481
- **Gender:** Man
- **Credential:** MSN, APRN, AGACNP-BC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2100X | Acute Care Nurse Practitioner | 0024190222 | VA | Yes |
| 363LA2100X | Acute Care Nurse Practitioner | 1029618 | TX | — |

## Other

- **Enumeration date:** 02/12/2021
- **Last updated:** 06/21/2024