Individual
LINDA D JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN,MSN,NP-C
Contact information
Practice address
1925 E ORMAN AVE, SUITE A 535, PUEBLO, CO 81004-3537
(719) 564-0450
(719) 564-1659
Mailing address
694 S CALAVERAS DR, PUEBLO WEST, CO 81007-1942
(719) 564-0450
(719) 564-1659
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
CO76267
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38330750
—
CO
Enumeration date
09/24/2006
Last updated
12/06/2013
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