Individual
ROGER JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
171 NOAH LN, LA FOLLETTE, TN 37766-5575
(423) 912-5097
Mailing address
171 NOAH LN, LA FOLLETTE, TN 37766-5575
(423) 912-5097
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
102279
TN
163WC1500X
Community Health Registered Nurse
102279
TN
163WH0200X
Home Health Registered Nurse
Primary
102279
TN
163WH1000X
Hospice Registered Nurse
102279
TN
163WM0705X
Medical-Surgical Registered Nurse
102279
TN
163WN1003X
Nutrition Support Registered Nurse
102279
TN
Other
Enumeration date
05/24/2021
Last updated
05/24/2021
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