Individual
MRS. JACQUELYN DENISE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, BSN, MSN-PH, AN
Contact information
Practice address
650 HUEBNER RD, FT RILEY, KS 66442-4030
(785) 239-7727
Mailing address
247 RIDGE OAK DR, RED OAK, TX 75154-5031
(469) 350-3557
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R078719
AR
163WC0400X
Case Management Registered Nurse
Primary
R078719
AR
2083P0901X
Public Health & General Preventive Medicine Physician
R078719
AR
Other
Enumeration date
09/08/2021
Last updated
08/08/2023
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