Healthcare Provider Details

I. General information

NPI: 1003489618
Provider Name (Legal Business Name): EMMALINE SUE JACKSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2224 US HIGHWAY 87 E TRLR 14
BILLINGS MT
59101-6601
US

IV. Provider business mailing address

2224 US HIGHWAY 87 E TRLR 14
BILLINGS MT
59101-6601
US

V. Phone/Fax

Practice location:
  • Phone: 406-208-4450
  • Fax:
Mailing address:
  • Phone: 406-208-4450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number290534
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: