Healthcare Provider Details

I. General information

NPI: 1235622929
Provider Name (Legal Business Name): CHELSEA NICOLE JACKSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3922 W MARKET ST
GREENSBORO NC
27407-1304
US

IV. Provider business mailing address

PO BOX 360
SYLVA NC
28779-0360
US

V. Phone/Fax

Practice location:
  • Phone: 336-252-3993
  • Fax: 855-308-2340
Mailing address:
  • Phone: 888-339-6065
  • Fax: 828-538-4441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5010583
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: