Healthcare Provider Details

I. General information

NPI: 1346181153
Provider Name (Legal Business Name): VICTORIA BROOKE JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 QUADRANGLE DR STE 500
CHAPEL HILL NC
27517-8281
US

IV. Provider business mailing address

6330 QUADRANGLE DR STE 500
CHAPEL HILL NC
27517-8281
US

V. Phone/Fax

Practice location:
  • Phone: 984-243-2976
  • Fax:
Mailing address:
  • Phone: 984-243-2976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4053668
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: