Individual
STEPHANIE J. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
705 RILEY HOSPITAL DR, ROC 4270, INDIANAPOLIS, IN 46202-5109
(317) 274-7208
(317) 274-7227
Mailing address
PO BOX 1026, INDIANAPOLIS, IN 46206-1026
(317) 274-1201
(317) 278-9905
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
125053014
IL
2080S0012X
Pediatric Sleep Medicine Physician
Primary
01071127A
IN
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
01071127
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201107390
—
IN
Enumeration date
07/30/2008
Last updated
01/12/2021
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