Individual
MRS. KAITLYN HANSEN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, CPNP-PC, RN
Contact information
Practice address
801 AMSTERDAM AVE, NEW YORK, NY 10025-5752
(212) 749-1820
Mailing address
110 W 97TH ST, NEW YORK, NY 10025-6450
(347) 893-6833
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
383070
NY
Other
Enumeration date
11/12/2019
Last updated
12/01/2025
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