Individual
MRS. AMY J JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2210 JACKSON ST, ANDERSON, IN 46016-4363
(765) 683-3118
Mailing address
2210 JACKSON ST, ANDERSON, IN 46016-4363
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71003983A
IN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
71003983A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000772417
ANTHEM
—
05
—
201072860
—
IN
Enumeration date
06/22/2012
Last updated
12/08/2023
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