Healthcare Provider Details

I. General information

NPI: 1780505479
Provider Name (Legal Business Name): ALETHEIA JACKSON NURSE PRACTIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

542 BERLIN CROSS KEYS RD STE 3
SICKLERVILLE NJ
08081-4367
US

IV. Provider business mailing address

542 BERLIN CROSS KEYS RD STE 3
SICKLERVILLE NJ
08081-4367
US

V. Phone/Fax

Practice location:
  • Phone: 267-258-3387
  • Fax: 267-258-3387
Mailing address:
  • Phone: 267-258-3387
  • Fax: 267-258-3387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number26NJ15573600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: