Healthcare Provider Details

I. General information

NPI: 1285092593
Provider Name (Legal Business Name): RUTH JACKSON APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2016
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 PARK AVE
MEMPHIS TN
38119-3505
US

IV. Provider business mailing address

10135 BLOOMSBURY AVE
CORDOVA TN
38016-0198
US

V. Phone/Fax

Practice location:
  • Phone: 901-383-7078
  • Fax:
Mailing address:
  • Phone: 901-246-5120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20545
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: