Individual
MERCEDES DENISE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN, CPST
Contact information
Practice address
12961 DUNSTONE DR, FLORISSANT, MO 63033-4702
(314) 479-8661
Mailing address
12961 DUNSTONE DR, FLORISSANT, MO 63033-4702
(314) 479-8661
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
043125373
IL
164W00000X
Licensed Practical Nurse
Primary
2010039936
MO
171400000X
Health & Wellness Coach
—
—
171M00000X
Case Manager/Care Coordinator
—
—
174H00000X
Health Educator
—
—
Other
Enumeration date
11/13/2024
Last updated
11/13/2024
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