Healthcare Provider Details

I. General information

NPI: 1982008918
Provider Name (Legal Business Name): KRISTEN JACKSON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BUNET AVENUE MLC 5021
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BUNET AVENUE MLC 7015
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4225
  • Fax:
Mailing address:
  • Phone: 513-636-4266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.16697
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: