Individual
JACKSON NORRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
406 S DALLAS ST, URBANA, MO 65767-9144
(417) 993-1002
Mailing address
PO BOX 125, HERMITAGE, MO 65668-0125
(417) 745-0103
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2023088856
MO
Other
Enumeration date
08/02/2023
Last updated
08/02/2023
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