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Individual

KELLY NICOLE JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP

Contact information

Practice address
4 SHERIDAN SQ STE 102, KINGSPORT, TN 37660-7435
(423) 588-7140
(423) 588-7141
Mailing address
6016 BROOKVALE LN STE 200, KNOXVILLE, TN 37919-4092
(865) 862-0998
(865) 544-1861

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
30680
TN

Other

Enumeration date
12/13/2021
Last updated
05/21/2026
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