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Individual

MEGAN JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP-C

Contact information

Practice address
1650 COWLES ST, FAIRBANKS, AK 99701-5907
(907) 458-5100
(907) 458-5151
Mailing address
1213 N EATON AVE, INDIANAPOLIS, IN 46219-4026

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
198878
AK
363LF0000X
Family Nurse Practitioner
2819322A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
198878
APRN LICENSE
AK
05
201282850
IN
01
71005406A
APN LICENSE
IN
01
P01512420
MEDICARE RR
IN
Enumeration date
02/15/2015
Last updated
03/20/2023
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