Individual
MRS. TRACY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1389 N BALDWIN AVE, MARION, IN 46952-1913
(765) 618-2118
Mailing address
1389 N BALDWIN AVE, MARION, IN 46952-1913
(765) 618-2118
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
28147465A
IN
Other
Enumeration date
05/19/2009
Last updated
11/22/2013
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