# ROGER JACKSON

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

## Provider details

- **NPI number:** 1720653629
- **Gender:** Man

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WC0400X | Case Management Registered Nurse | 102279 | TN | — |
| 163WC1500X | Community Health Registered Nurse | 102279 | TN | — |
| 163WH0200X | Home Health Registered Nurse | 102279 | TN | Yes |
| 163WH1000X | Hospice Registered Nurse | 102279 | TN | — |
| 163WM0705X | Medical-Surgical Registered Nurse | 102279 | TN | — |
| 163WN1003X | Nutrition Support Registered Nurse | 102279 | TN | — |

## Other

- **Enumeration date:** 05/24/2021
- **Last updated:** 05/24/2021