Healthcare Provider Details

I. General information

NPI: 1316191968
Provider Name (Legal Business Name): TOKEYSHA JOHNSON JACKSON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2008
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMMUNITY CARE BUILDING 908 20TH STREET
BIRMINGHAM AL
35294-1047
US

IV. Provider business mailing address

709 GRISWOLD RD
FAIRFIELD AL
35064-2808
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-1917
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number1-108932
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-108932
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: