Individual
ALYSIA DIANE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
1020 26TH ST S, BIRMINGHAM, AL 35205-2412
(205) 332-3155
Mailing address
116 SPRING ST, CALERA, AL 35040-4971
(205) 482-7480
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1-143723
AL
Other
Enumeration date
01/02/2018
Last updated
01/02/2018
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