Individual
JACQUELYNNE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, BSN
Contact information
Practice address
1 JEFFERSON BARRACKS DR, SAINT LOUIS, MO 63125-4181
(314) 894-6654
(314) 894-5775
Mailing address
119 RED FOX RD, BELLEVILLE, IL 62223-2242
(618) 444-5071
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
2000158981
MO
Other
Enumeration date
01/16/2024
Last updated
01/31/2024
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