Individual
KARISSA KEAGAN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNPC-AG
Contact information
Practice address
1776 PARK AVE STE 211, PARK CITY, UT 84060-5148
(385) 464-3980
(385) 464-3990
Mailing address
1776 PARK AVE STE 211, PARK CITY, UT 84060-5148
(385) 464-3980
(385) 464-3990
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
7120828-4405
UT
Other
Enumeration date
02/18/2020
Last updated
06/02/2024
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