Individual
CAROLYN A JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP 01675
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
JA2027601
MEDICARE FQHC PIN
OH
Enumeration date
05/23/2006
Last updated
03/07/2023
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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