Individual
JENNIFER MARIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2007-00654
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810009251
—
WV
05
—
5907036
—
NC
05
—
Q00651
—
SC
Enumeration date
05/25/2007
Last updated
03/29/2011
Update your record
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