Individual
KATHLEEN J. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN-APN
Contact information
Practice address
1331 MAESTAS RD, TAOS, NM 87571-6268
(575) 776-7806
(575) 224-3348
Mailing address
602 WCUTHBERT BLVD UNIT 26 STE A, UNIT 26, SUITE A, WESTMONT, NJ 08108-4197
(856) 946-5180
(856) 946-5181
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
TP001754C
PA
363LA2200X
Adult Health Nurse Practitioner
26NN06425500
NJ
363LF0000X
Family Nurse Practitioner
Primary
26NN06425500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60037187
HORIZON NJ HEALTH
NJ
05
—
8780803
—
NJ
01
—
9765851
CIGNA
NJ
01
—
P3845837/2854869
OXFORD/UNITED HLTH.
NJ
Enumeration date
09/16/2006
Last updated
04/24/2026
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