Individual
LEA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1481 W 10TH ST, INDIANAPOLIS, IN 46202-2803
(317) 554-0000
Mailing address
1481 W 10TH ST, INDIANAPOLIS, IN 46202-2803
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71012301A
IN
363LF0000X
Family Nurse Practitioner
AP60914149
WA
363LF0000X
Family Nurse Practitioner
N360922794
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Q00387667
RAILROAD MEDICARE
IN
Enumeration date
10/29/2018
Last updated
10/06/2023
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