Individual
MRS. HEIDI LYNN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
USAMEDDAC, 2480 LLEWELLYN AVE, FORT GEORGE G MEADE, MD 20755
(410) 287-3417
Mailing address
50 PINEY RIDGE LN, NORTH EAST, MD 21901-2101
(410) 287-3417
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
R070129
MD
Other
Enumeration date
12/27/2005
Last updated
02/26/2025
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