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Individual

NICOLE JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RNCLINICAL THERAPIST

Contact information

Practice address
2124 MARTIN LUTHER KING JR AVE SE, WASHINGTON, DC 20020-5732
(817) 217-9825
Mailing address
2124 MARTIN LUTHER KING JR AVE SE, WASHINGTON, DC 20020-5732
(817) 217-9825

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
500020205
DC
163WC0400X
Case Management Registered Nurse
500020205
DC
364S00000X
Clinical Nurse Specialist
500020205
DC

Other

Enumeration date
06/11/2025
Last updated
06/11/2025
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