Individual
KRISTEN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1024 N MAGNOLIA ST, ELMWOOD, IL 61529-9602
(309) 742-6334
(309) 649-6880
Mailing address
180 S MAIN ST, CANTON, IL 61520-2608
(309) 647-0201
(309) 647-8613
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041412141
IL
363L00000X
Nurse Practitioner
Primary
209016808
IL
Other
Enumeration date
08/30/2017
Last updated
07/07/2021
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