Individual
MR. ANDREW CRAIG JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
200 HOSPITAL AVE, JEFFERSON, NC 28640-9244
(336) 846-0719
Mailing address
244 FALLS CREEK RD, TODD, NC 28684-9219
(336) 877-2047
(336) 877-5545
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
085415
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8049903
—
NC
Enumeration date
08/25/2005
Last updated
10/28/2008
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