Individual
MR. MARK WAYNE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1901 CLINCH AVE, KNOXVILLE, TN 37916-2307
(865) 331-1111
Mailing address
68 S SERVICE RD STE 350, MELVILLE, NY 11747-2358
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
1123A
KY
367500000X
Certified Registered Nurse Anesthetist
Primary
9250
TN
Other
Enumeration date
04/23/2007
Last updated
01/06/2022
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