Individual
CAROLYN A JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
37984 AIRPORT RD, WOODSFIELD, OH 43793-9247
(740) 472-0757
(740) 472-0283
Mailing address
PO BOX 658, WOODSFIELD, OH 43793-0658
(740) 472-5167
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
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