Individual
MS. ATEEYA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
1501 N BROAD ST, PHILADELPHIA, PA 19122-3319
(267) 457-5553
Mailing address
325 CHESTNUT ST STE 876, PHILADELPHIA, PA 19106-2614
(215) 929-6116
Taxonomy
Speciality
Code
Description
License number
State
163WI0500X
Infusion Therapy Registered Nurse
RN623432
PA
363L00000X
Nurse Practitioner
Primary
26NJ1540330
NJ
363LF0000X
Family Nurse Practitioner
SP030946
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6957677
—
PA
Enumeration date
11/11/2021
Last updated
10/31/2025
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