Individual
TIERRA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
340 STATELINE RD W, SOUTHAVEN, MS 38671-1610
(662) 579-3955
Mailing address
116 HYDE RD, SENATOBIA, MS 38668-5848
(901) 674-0950
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
904700
MS
Other
Enumeration date
06/03/2021
Last updated
06/03/2021
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