Individual
NIKKITTA ANTOINETTE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
20245 W 12 MILE RD STE 145, SOUTHFIELD, MI 48076-6403
(734) 299-0208
Mailing address
20245 W 12 MILE RD, SOUTHFIELD, MI 48076-5409
(734) 299-0208
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703117130
MI
225700000X
Massage Therapist
7501017098
MI
Other
Enumeration date
09/07/2016
Last updated
12/22/2025
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