Individual
MS. LISA LANETTE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
1117 CHESTNUT ST, LEWISVILLE, AR 71845
(870) 921-5781
(870) 798-4100
Mailing address
1117 CHESTNUT, LEWISVILLE, AR 71845-1117
(870) 921-5781
(870) 798-4100
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
A02932 ANP
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202614758
—
AR
Enumeration date
11/15/2006
Last updated
05/29/2015
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