Individual
MRS. ASHANTI JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
11200 TARA GLYNN DR, HAMPTON, GA 30228-2686
(314) 386-7137
Mailing address
11200 TARA GLYNN DR, HAMPTON, GA 30228-2686
(314) 736-0679
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
2018040059
MO
Other
Enumeration date
03/17/2023
Last updated
03/17/2023
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