Healthcare Provider Details

I. General information

NPI: 1972434785
Provider Name (Legal Business Name): AYANA JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4535 NORMAL BLVD
LINCOLN NE
68506-5576
US

IV. Provider business mailing address

4535 NORMAL BLVD
LINCOLN NE
68506-5576
US

V. Phone/Fax

Practice location:
  • Phone: 402-620-6673
  • Fax:
Mailing address:
  • Phone: 402-620-6673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: