Individual
DR. ELLANIKOLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP
Contact information
Practice address
11268 HIGHWAY 57, COUNCE, TN 38326-3802
(731) 438-3456
Mailing address
PO BOX 140, PICKWICK DAM, TN 38365-0140
(731) 689-4357
(731) 689-1050
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
24869
TN
Other
Enumeration date
10/25/2018
Last updated
07/24/2024
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