Individual
IRMA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1633 HOSPITAL ST, GREENVILLE, MS 38703-3222
(662) 332-8177
(662) 378-3783
Mailing address
1633 HOSPITAL ST, GREENVILLE, MS 38703-3222
(662) 332-8177
(662) 378-3783
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
R511587
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00123993
—
MS
Enumeration date
02/07/2007
Last updated
07/09/2007
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