Individual
STACY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
201 WIGGINS RD APT 13, INDIANOLA, MS 38751-3478
(662) 303-6959
Mailing address
201 WIGGINS RD APT 13, INDIANOLA, MS 38751-3478
(662) 303-6959
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Enumeration date
04/28/2017
Last updated
04/28/2017
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