Doctor Name: | KERRI S JACKSON |
NPI Number: | 1477883809 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | 0024168602 |
Business Practice Address: | 583c E Riverside Dr North Tazewell, VA - 246309573 |
Business Phone Number: | 2769799899 |
Business Fax Number: | 2769799798 |
Mailing Address: | 583c E Riverside Dr, NORTH TAZEWELL |
State: | VA |
Postal Code: | 246309573 |
Phone Number: | 2769799899 |
Fax Number: | 2769799798 |
NPI Enumeration Date: | 01/07/2010 |
NPI Last Update Date: | 10/16/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 0024168602 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |