Individual
TASHEKA L JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4204 E MALLORY AVE, MEMPHIS, TN 38111-7819
(901) 649-0305
(601) 340-9588
Mailing address
4204 E MALLORY AVE, MEMPHIS, TN 38111-7819
(901) 649-0305
(601) 340-9588
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
01/27/2022
Last updated
01/27/2022
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