Individual
MRS. CHRISTINE DENISE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN,FNP-C
Contact information
Practice address
324 COURTHOUSE SQ, BAY MINETTE, AL 36507-4809
(251) 580-2555
Mailing address
324 COURTHOUSE SQ, BAY MINETTE, AL 36507-4809
(251) 580-2555
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1-130303
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011846
MEDICARE GROUP NUMBER
AL
01
—
1063439065
NPI GROUP PAYEE NUMBER
AL
05
—
630000013
—
AL
Enumeration date
02/25/2009
Last updated
09/03/2019
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