| Doctor Name: | MRS. KRISTEN JACKSON |
| NPI Number: | 1255727061 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN, BSN |
| License Number: | 658192 |
| Business Practice Address: | 4028 Connors Way Blasdell, NY - 142192985 |
| Business Phone Number: | 6315145308 |
| Business Fax Number: | |
| Mailing Address: | 4028 Connors Way, BLASDELL |
| State: | NY |
| Postal Code: | 142192985 |
| Phone Number: | 6315145308 |
| Fax Number: | |
| NPI Enumeration Date: | 04/08/2015 |
| NPI Last Update Date: | 04/08/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WH0200X |
| License Number: | 658192 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Home Health |
| Taxonomy Definition: | |