Individual
PRENNA DORIZ JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9930 KINCEY AVE STE 100, HUNTERSVILLE, NC 28078-6541
(855) 501-1004
Mailing address
3835 N FREEWAY BLVD STE 100, SACRAMENTO, CA 95834-1954
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-12121
NC
363AM0700X
Medical Physician Assistant
Primary
0010-12121
NC
Other
Enumeration date
04/02/2022
Last updated
04/17/2026
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