Individual
JOHNNIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1901 W COUNTY LINE RD, JACKSON, MS 39213-7847
(601) 497-1306
(601) 366-5949
Mailing address
1901 W COUNTY LINE RD, JACKSON, MS 39213-7847
(601) 497-1306
(601) 366-5949
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R127260
MS
Other
Enumeration date
12/29/2014
Last updated
12/29/2014
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