Individual
DOMINIQUE TERENCE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
1791 ALUM CREEK DR STE 100, COLUMBUS, OH 43207
(614) 526-5420
(614) 645-5517
Mailing address
2780 AIRPORT DR STE 100, COLUMBUS, OH 43219-2289
(614) 859-1906
(614) 645-5517
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APRN.CNP.024669
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/12/2019
Last updated
08/06/2019
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