Individual
SAMANTHA ANN JACKSON
Active
Individual
SAMANTHA ANN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
71002751A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200930050
—
IN
01
—
P01235984
MEDICARE RR PTAN
IN
Enumeration date
12/29/2008
Last updated
06/11/2021
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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