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Individual

CYNTHIA JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PSYCH NP

Contact information

Practice address
6093 S QUEBEC ST STE 100, CENTENNIAL, CO 80111-4543
(303) 770-6933
Mailing address
6093 S QUEBEC ST STE 100, CENTENNIAL, CO 80111-4543
(303) 770-6933

Taxonomy

Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
176692
CO
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
990052
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
71671218
CO
Enumeration date
10/04/2006
Last updated
07/21/2021
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