Individual
ANDREA MICHELE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 WILBURN WAY, STARKVILLE, MS 39759-3692
(662) 320-4008
Mailing address
100 WILBURN WAY, STARKVILLE, MS 39759-3692
(662) 320-4008
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
902906
MS
Other
Enumeration date
09/11/2018
Last updated
09/11/2018
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