Healthcare Provider Details

I. General information

NPI: 1851795876
Provider Name (Legal Business Name): LINDSEY JACKSON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 MAIN ST N
BUDE MS
39630-7117
US

IV. Provider business mailing address

136 MAIN ST N
BUDE MS
39630-7117
US

V. Phone/Fax

Practice location:
  • Phone: 601-384-2394
  • Fax: 601-384-2396
Mailing address:
  • Phone: 601-384-2394
  • Fax: 601-384-2396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR874215
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: