Individual
MELISSA A JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP PMHNP-BC
Contact information
Practice address
9809 S FRANKLIN DR STE 302, FRANKLIN, WI 53132-8885
(262) 999-3495
Mailing address
9809 S FRANKLIN DR STE 302, FRANKLIN, WI 53132-8885
(262) 269-2272
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
16250-30
WI
163WX0003X
Inpatient Obstetric Registered Nurse
16250-30
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
10436-33
WI
Other
Enumeration date
07/20/2020
Last updated
10/07/2024
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