Individual
MRS. CANDICE GRACE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
2001 E SOUTH BLVD STE 101, MONTGOMERY, AL 36116-2463
(334) 747-5050
Mailing address
301 BROWN SPRINGS RD, MONTGOMERY, AL 36117-7005
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1-156024
AL
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/24/2022
Last updated
02/23/2026
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