MEDICARE: SERENA JEFFERSON-JACKSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	209.034924	IL

General Provider Information

NPI Number	:	1972459352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERENA JEFFERSON-JACKSON

Provider Business Mailing Address
First Line	:	PO BOX 528135
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60652-8135
Country	:	US
Telephone Number	:	630-426-8963
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 528135
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60652-8135
Country	:	US
Telephone Number	:	630-426-8963
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2026
Last Update Date	:	03/07/2026

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Directions to “ SERENA JEFFERSON-JACKSON ” Practice Location

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