Healthcare Provider Details

I. General information

NPI: 1013872324
Provider Name (Legal Business Name): JILLIAN WHITE JACKSON AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HEALTH PARK DR STE 100
GARNER NC
27529-4679
US

IV. Provider business mailing address

3056 N SHILOH RD
GARNER NC
27529-8132
US

V. Phone/Fax

Practice location:
  • Phone: 919-773-1223
  • Fax:
Mailing address:
  • Phone: 919-559-5244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5023659
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: