Individual
CANDICE LATRICE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP, PMHNP
Contact information
Practice address
5210 COMMERCE CIR STE B, INDIANAPOLIS, IN 46237-9853
(463) 999-9203
(463) 388-2323
Mailing address
5210 COMMERCE CIR STE B, INDIANAPOLIS, IN 46237-9853
(317) 493-6456
(463) 388-2323
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
71009203A
IN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
71009203B
IN
Other
Enumeration date
02/10/2019
Last updated
02/05/2026
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