Individual
CARLA MARIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
4903 HIGHWAY 67 W, FULTON, AR 71838-9033
(903) 244-5368
Mailing address
PO BOX 7395, TEXARKANA, TX 75505-7395
(903) 244-5368
Taxonomy
Speciality
Code
Description
License number
State
261QI0500X
Infusion Therapy Clinic/Center
1036336
TX
261QP2300X
Primary Care Clinic/Center
1036336
TX
363LP2300X
Primary Care Nurse Practitioner
Primary
1036336
TX
Other
Enumeration date
10/27/2022
Last updated
10/27/2022
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