Individual
CHRISTA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
G179008
IA
367A00000X
Advanced Practice Midwife
Primary
B118673
IA
Other
Enumeration date
10/01/2010
Last updated
07/10/2024
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