Individual
SUSAN K JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
521 N BRIGHTLEAF BLVD, SMITHFIELD, NC 27577-4407
(919) 989-5500
Mailing address
PO BOX 411, SMITHFIELD, NC 27577-0411
(919) 989-5500
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
RN074602
NC
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
NP005000618
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6005045
—
NC
Enumeration date
10/13/2006
Last updated
02/22/2013
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