Individual
ANGELA ALLEN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
1010 LAKELAND PL, FLOWOOD, MS 39232-6678
(601) 815-0600
Mailing address
2500 N STATE STREET, UMMC-DEPARTMENT OF DERMATOLOGY, JACKSON, MS 39216-4500
(601) 815-3374
(601) 815-0983
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R873582
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05728527
—
MS
Enumeration date
08/18/2010
Last updated
10/06/2017
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