Individual
QUIANA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
8021 WATSON RD, WEBSTER GROVES, MO 63119-5304
(866) 389-2727
Mailing address
365 MESSINA DR, BALLWIN, MO 63021-6411
(314) 761-6367
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2022040712
MO
Other
Enumeration date
12/07/2022
Last updated
12/07/2022
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