Individual
AMY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17083 PALM RIDGE DR, DIBERVILLE, MS 39540-8819
(985) 788-4269
Mailing address
17083 PALM RIDGE DR, DIBERVILLE, MS 39540-8819
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
927917
MS
Other
Enumeration date
08/01/2025
Last updated
08/01/2025
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