Individual
KELLY ROSE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
WHCNP, CNM
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
10002453
OR
367A00000X
Advanced Practice Midwife
Primary
10005243
OR
Other
Enumeration date
12/15/2022
Last updated
12/10/2024
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