Individual
HEATHER ANN TAYLOR JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, WHNP-BC
Contact information
Practice address
1504 W REYNOLDS ST STE C, PONTIAC, IL 61764-9786
(309) 604-9505
(309) 604-9501
Mailing address
611 W PARK ST, FAPC, URBANA, IL 61801
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209026979
IL
Other
Enumeration date
08/02/2023
Last updated
02/05/2024
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