Individual
GLORIA J. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
9097 COLLINSVILLE RD, COLLINSVILLE, MS 39325-9779
(601) 626-8874
(601) 626-8592
Mailing address
PO BOX 2106, MERIDIAN, MS 39302-2106
(601) 703-4282
(601) 703-4597
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R715654
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09573377
—
MS
01
—
730-15594
BLUE CROSS OF AL
—
05
—
891010060
—
AL
Enumeration date
11/22/2005
Last updated
11/06/2013
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