| Doctor Name: | GLORIA J. JACKSON |
| NPI Number: | 1245213354 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | R715654 |
| Business Practice Address: | 9097 Collinsville Rd Collinsville, MS - 393259779 |
| Business Phone Number: | 6016268874 |
| Business Fax Number: | 6016268592 |
| Mailing Address: | Po Box 2106, MERIDIAN |
| State: | MS |
| Postal Code: | 393022106 |
| Phone Number: | 6017034282 |
| Fax Number: | 6017034597 |
| NPI Enumeration Date: | 11/22/2005 |
| NPI Last Update Date: | 11/06/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | R715654 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |