Individual
MRS. PRISCILLA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
225 COMMUNITY DRIVE, FAYETTE, MS 39069
(601) 786-8206
(601) 786-6320
Mailing address
21 N PALESTINE RD, NATCHEZ, MS 39120-9007
(601) 597-0229
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R852296
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0121708
—
MS
05
—
1783048
—
LA
Enumeration date
10/17/2006
Last updated
07/08/2007
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