Individual
MRS. JEAN Z JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-BC, RN
Contact information
Practice address
950 S OYSTER BAY RD, HICKSVILLE, NY 11801-3511
(516) 822-6111
Mailing address
16 LEEDS LN, NORTH BABYLON, NY 11703-2902
(516) 314-4199
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
326644-1
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
405610
NY
Other
Enumeration date
06/09/2023
Last updated
07/01/2024
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