Healthcare Provider Details

I. General information

NPI: 1902728355
Provider Name (Legal Business Name): PRISTINA JACKSON CPRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 E BARTHMAN AVE
COLUMBUS OH
43207-1980
US

IV. Provider business mailing address

312 E BARTHMAN AVE
COLUMBUS OH
43207-1980
US

V. Phone/Fax

Practice location:
  • Phone: 614-975-0325
  • Fax:
Mailing address:
  • Phone: 614-975-0325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberPRS008109
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: