Individual
MATT JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
AGAC NP- BC
Contact information
Practice address
676 N SAINT CLAIR ST STE 650, CHICAGO, IL 60611-2929
(312) 695-3800
(312) 695-3644
Mailing address
676 N SAINT CLAIR ST STE 650, CHICAGO, IL 60611-2929
(312) 695-3800
(312) 695-3644
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209015073
IL
363LA2100X
Acute Care Nurse Practitioner
209.015073
IL
Other
Enumeration date
11/07/2016
Last updated
01/28/2026
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