Individual
MRS. STEVIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
1007 W CONGRESS ST, BROOKHAVEN, MS 39601-2603
(601) 847-3712
Mailing address
1827 SIMPSON HIGHWAY 149, MENDENHALL, MS 39114-3439
(601) 894-6669
(601) 894-4721
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
901629
MS
Other
Enumeration date
12/01/2016
Last updated
03/17/2017
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