Individual
KELLY NICOLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
400 N STATE OF FRANKLIN RD, JOHNSON CITY, TN 37604-6035
(423) 431-2922
Mailing address
2382 OLD STAGECOACH RD, JONESBOROUGH, TN 37659-4868
(423) 431-2922
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
30680
TN
Other
Enumeration date
12/13/2021
Last updated
12/13/2021
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