Individual
KATRINA A JACKSON
Active
Individual
KATRINA A JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
C00815
AR
367500000X
Certified Registered Nurse Anesthetist
Primary
C00815
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5S440
AR BLUE CROSS BLUE SHIELD
AR
Enumeration date
10/11/2006
Last updated
03/02/2010
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