Individual
LESLEY TYESHA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
900 COOPER ST, JACKSON, MI 49202-3398
(800) 379-1600
Mailing address
900 COOPER ST, JACKSON, MI 49202-3398
(800) 379-1600
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704244746
MI
363LF0000X
Family Nurse Practitioner
Primary
4704244746
MI
Other
Enumeration date
02/03/2009
Last updated
08/16/2016
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