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Individual

TYESHA BROOKES JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
905 PHILLIPS AVE, HIGH POINT, NC 27262-7075
(368) 022-0403
(336) 802-2041
Mailing address
100 KIMEL FOREST DR, WINSTON SALEM, NC 27103-6074
(336) 716-1331

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5015370
NC
363LF0000X
Family Nurse Practitioner
5015370
NC

Other

Enumeration date
11/05/2021
Last updated
10/26/2022
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