Healthcare Provider Details

I. General information

NPI: 1497953152
Provider Name (Legal Business Name): FELICIA ATHENS JACKSON PH.D., MCJ, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2007
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4634 BELFAST DR
COLUMBUS OH
43227-2527
US

IV. Provider business mailing address

4634 BELFAST DR
COLUMBUS OH
43227-2527
US

V. Phone/Fax

Practice location:
  • Phone: 614-861-0983
  • Fax: 614-860-0487
Mailing address:
  • Phone: 614-861-0983
  • Fax: 614-860-0487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN26987
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN269287
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN269287
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN269287
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN269287
License Number StateOH
# 6
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN269287
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: