Doctor Name: | MRS. HEIDI LYNN JACKSON |
NPI Number: | 1831176239 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CPNP |
License Number: | R070129 |
Business Practice Address: | 2501 Oakington St Aberdeen Proving Ground, MD - 210055131 |
Business Phone Number: | 4102781932 |
Business Fax Number: | |
Mailing Address: | 50 Piney Ridge Ln, NORTH EAST |
State: | MD |
Postal Code: | 219012101 |
Phone Number: | 4102873417 |
Fax Number: | |
NPI Enumeration Date: | 12/27/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0200X |
License Number: | R070129 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |