Individual
JENNIFER L JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2341 MCCALLIE AVE, SUITE 402, CHATTANOOGA, TN 37404-3239
(423) 698-3309
(423) 624-6355
Mailing address
PO BOX 3549, CHATTANOOGA, TN 37404-0549
(423) 698-3309
(423) 624-6355
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
APN16918
TN
367500000X
Certified Registered Nurse Anesthetist
RN147906
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1530475
—
TN
01
—
4335469
BC BS OF TN
TN
01
—
P01124805
RAILROAD MEDICARE
—
Enumeration date
09/24/2012
Last updated
02/07/2013
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