| Doctor Name: | VICKIE LYNNE JACKSON |
| NPI Number: | 1942699566 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 1-067105 |
| Business Practice Address: | 29495 Copperhead Ln Elkmont, AL - 356205931 |
| Business Phone Number: | 2567324452 |
| Business Fax Number: | 2567324430 |
| Mailing Address: | 29495 Copperhead Ln, ELKMONT |
| State: | AL |
| Postal Code: | 356205931 |
| Phone Number: | 2567324452 |
| Fax Number: | 2567324430 |
| NPI Enumeration Date: | 01/20/2015 |
| NPI Last Update Date: | 01/20/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WA0400X |
| License Number: | 1-067105 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AL |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |