| Doctor Name: | MRS. ROSEMARY ANN JACKSON |
| NPI Number: | 1285076059 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PMHNP-BC |
| License Number: | 24171010 |
| Business Practice Address: | 576 Jefferson Ave. Fort Eustis, VA - 236045548 |
| Business Phone Number: | 7573147500 |
| Business Fax Number: | 7573147854 |
| Mailing Address: | 9 Fauquier Pl, NEWPORT NEWS |
| State: | VA |
| Postal Code: | 236082005 |
| Phone Number: | 7578746449 |
| Fax Number: | |
| NPI Enumeration Date: | 07/22/2013 |
| NPI Last Update Date: | 08/07/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | 24171010 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |