Individual
LORI A JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2423 N NATIONAL RD, COLUMBUS, IN 47201-3733
(866) 389-2727
Mailing address
2423 N NATIONAL RD, COLUMBUS, IN 47201-3733
(866) 389-2727
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71001952A
IN
363LF0000X
Family Nurse Practitioner
28142046A
IN
363LF0000X
Family Nurse Practitioner
Primary
71001952A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200801400
—
IN
Enumeration date
07/25/2006
Last updated
02/03/2022
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