Individual
NIKKITA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
454 WESTCHESTER AVENUE, PORT CHESTER, NY 10573
(914) 351-0650
Mailing address
454 WESTCHESTER AVENUE, PORT CHESTER, NY 10573
(914) 351-0650
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
788484
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
131740445
N/A
NY
Enumeration date
07/23/2020
Last updated
07/23/2020
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