Individual
ANTHONY BENEDICT JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
3724 RALEIGH ROAD PKWY W, WILSON, NC 27896-9742
(252) 246-8840
Mailing address
42 BULL RIVER ST, CLAYTON, NC 27527-3402
(850) 543-9051
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
JACK-AA4P9
NC
Other
Enumeration date
08/24/2020
Last updated
07/18/2022
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