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Individual
JEANINE M. JACKSON
Active
Individual
JEANINE M. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNNP
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
RN060702
GA
363LP0200X
Pediatric Nurse Practitioner
Primary
RN060702
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000731497A
—
GA
05
—
000731497B
—
GA
05
—
000731497D
—
GA
05
—
000731497E
—
GA
05
—
000731497F
—
GA
01
—
10032991
AMERIGROUP
GA
01
—
302375
WELLCARE
GA
01
—
302385
WELLCARE
GA
01
—
302386
WELLCARE
GA
01
—
302387
WELLCARE
GA
Enumeration date
02/06/2006
Last updated
10/25/2018
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