Individual
KESHA DOUGLAS-JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(872) 231-3162
(708) 795-0101
Mailing address
PO BOX 74008272, CHICAGO, IL 60674-8272
(702) 899-0595
(702) 977-1496
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209016670
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041410556
REGISTERED NURSE
IL
Enumeration date
10/01/2017
Last updated
10/08/2025
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