Individual
MICHAEL F JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
12639 OLD TESSON RD STE 130, SAINT LOUIS, MO 63128-4814
(636) 386-7222
(636) 386-7810
Mailing address
PO BOX 22407, SAINT LOUIS, MO 63126-0407
(636) 386-7222
(636) 386-7810
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
106810
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
913910147
—
MO
Enumeration date
01/19/2006
Last updated
01/30/2026
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