Healthcare Provider Details

I. General information

NPI: 1598699084
Provider Name (Legal Business Name): EMILY JACKSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2516 PULASKI HWY
COLUMBIA TN
38401-5753
US

IV. Provider business mailing address

2516 PULASKI HWY
COLUMBIA TN
38401-5753
US

V. Phone/Fax

Practice location:
  • Phone: 931-548-2656
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number189885
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: