Healthcare Provider Details

I. General information

NPI: 1366388522
Provider Name (Legal Business Name): JENNIFER JACKSON RN, BSN, LSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 4TH ST
WALKER MN
56484
US

IV. Provider business mailing address

PO BOX 4000
WALKER MN
56484-4000
US

V. Phone/Fax

Practice location:
  • Phone: 218-547-1311
  • Fax:
Mailing address:
  • Phone: 218-547-1311
  • Fax: 218-293-7191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number1830431
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: