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Individual
DR. PAMELA TAYLOR JACKSON
Active
Individual
DR. PAMELA TAYLOR JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DNP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
AP03530
LA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP03530
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1563404
—
LA
01
—
4B540
MEDICARE PTAN
LA
Enumeration date
10/30/2006
Last updated
04/10/2017
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