Individual
JUSTIN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1375 W RIDGE RD, WYTHEVILLE, VA 24382
(276) 228-8686
Mailing address
1375 W RIDGE RD, WYTHEVILLE, VA 24382-5011
(276) 228-8686
(276) 228-4125
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024180798
VA
Other
Enumeration date
02/28/2021
Last updated
11/22/2022
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