Individual
DOUGLAS JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1100 REID PKWY, RICHMOND, IN 47374-1157
(765) 983-3000
(765) 935-8944
Mailing address
1100 REID PARKWAY, MEDICAL STAFF SERVICE, RICHMOND, IN 47374
(765) 935-5331
(765) 983-3219
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71009145A
IN
363LA2100X
Acute Care Nurse Practitioner
Primary
APRN.CNP.0027550
OH
Other
Enumeration date
07/22/2019
Last updated
10/30/2024
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