Individual
ANASTASIA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
100 MERCY WAY, JOPLIN, MO 64804-4524
(417) 781-2727
Mailing address
5833 S 79TH EAST AVE, TULSA, OK 74145-8656
(310) 795-3752
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
943949
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
2024043054
MO
367500000X
Certified Registered Nurse Anesthetist
M135050
OK
Other
Enumeration date
08/05/2019
Last updated
01/14/2025
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