Individual
KRISTIE JACKSON
Active
Individual
KRISTIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
APN0000010926
TN
363LA2100X
Acute Care Nurse Practitioner
Primary
10926
TN
363LA2100X
Acute Care Nurse Practitioner
2004003624
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1519858
—
TN
01
—
6011957
BCBS
TN
01
—
P01167551
RR MEDICARE
TN
Enumeration date
01/23/2006
Last updated
07/10/2018
Update your record
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