Individual
CANDACE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
106 EVA DR, PEARL, MS 39208-5845
(601) 497-5345
Mailing address
106 EVA DR, PEARL, MS 39208-5845
(601) 497-5345
Taxonomy
Speciality
Code
Description
License number
State
171400000X
Health & Wellness Coach
—
—
174H00000X
Health Educator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
236
—
MS
01
—
568946544
BCBS
—
01
—
5874
HEALTH PROVIDER
—
Enumeration date
03/07/2023
Last updated
03/07/2023
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