Individual
TYRA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
120 N OAK ST, HINSDALE, IL 60521-3829
(630) 856-6825
Mailing address
420 S. SCHMIDT RD, SUITE 110, BOLINGBROOK, IL 60440
(630) 312-4505
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
209.033340
IL
Other
Enumeration date
12/04/2025
Last updated
12/04/2025
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