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Individual
SOPHIE JACKSON
Active
Individual
SOPHIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, CNM
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN10000713
MA
163W00000X
Registered Nurse
RN315147
GA
367A00000X
Advanced Practice Midwife
Primary
RN10000713
MA
Other
Enumeration date
09/19/2022
Last updated
06/29/2026
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