Individual
VANESSA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
3700 CAHABA BEACH RD, BIRMINGHAM, AL 35242-5225
(052) 512-5464
Mailing address
101 DELIA LN, MARION, AL 36756-3106
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2010002394
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1487975520
—
AL
Enumeration date
06/11/2010
Last updated
02/21/2020
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