Healthcare Provider Details

I. General information

NPI: 1427778471
Provider Name (Legal Business Name): PATRICIA JACKSON DNP, CRNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 S COURT SQ
TROY AL
36081-2609
US

IV. Provider business mailing address

500 N KNOX ST
TROY AL
36081-2800
US

V. Phone/Fax

Practice location:
  • Phone: 334-372-2162
  • Fax:
Mailing address:
  • Phone: 334-372-2162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-128321
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: