Individual
DEANNA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2615 GAULT AVE N, FORT PAYNE, AL 35967-3728
(256) 845-4134
(256) 845-4709
Mailing address
2615 GAULT AVE N, FORT PAYNE, AL 35967-3728
(256) 845-4134
(256) 845-4709
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1090205
AL
Other
Enumeration date
09/16/2016
Last updated
09/16/2016
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