Individual
MARY K JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
7927 N LINDBERGH BLVD, HAZELWOOD, MO 63042-3520
(615) 778-4066
Mailing address
720 COOL SPRINGS BLVD, SUITE 300, FRANKLIN, TN 37067-2626
(615) 778-4066
(615) 778-9114
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
082648
MO
Other
Enumeration date
03/27/2007
Last updated
07/08/2007
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