Organization
FOOT CARE ETC LLC
Active
Other names
FOOT CARE ETC LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GLORIA JEAN JACKSON NP (OWNER)
(601) 934-8217
Entity
Organization
Contact information
Practice address
3931 NEWELL RD, MERIDIAN, MS 39301-1440
(601) 934-8217
Mailing address
3931 NEWELL RD, MERIDIAN, MS 39301-1440
(601) 934-8217
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09573377
—
MS
01
—
297196YJ96
MEDICARE NUMBER
MS
Enumeration date
06/17/2024
Last updated
06/17/2024
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