Healthcare Provider Details

I. General information

NPI: 1235033382
Provider Name (Legal Business Name): JACLYN JACKSON-ERWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13502 MORGAN LEE AVE
CHARLOTTE NC
28213-4347
US

IV. Provider business mailing address

13502 MORGAN LEE AVE
CHARLOTTE NC
28213-4347
US

V. Phone/Fax

Practice location:
  • Phone: 704-293-4275
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: