Individual
MRS. BRITTANY AMBER JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.C
Contact information
Practice address
404 S SUTHERLAND AVE, MONROE, NC 28112-5060
(704) 291-9267
(704) 776-4078
Mailing address
404 S SUTHERLAND AVE, MONROE, NC 28112-5060
(704) 291-9267
(704) 776-4078
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-02343
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8101604
—
NC
01
—
NCO3388C
MEDICARE PTAN
NC
Enumeration date
07/20/2010
Last updated
10/14/2016
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