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Individual

LERIN JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PMHNP-BC

Contact information

Practice address
5401 OLD COURT RD, RANDALLSTOWN, MD 21133-5103
(443) 488-3645
Mailing address
1925 HILLENWOOD RD, BALTIMORE, MD 21239-3620
(443) 488-3645

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R200117
MD

Other

Enumeration date
01/15/2020
Last updated
01/15/2020
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