Healthcare Provider Details

I. General information

NPI: 1992204796
Provider Name (Legal Business Name): JADE C JACKSON APNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JADE C KOEUNE

II. Dates (important events)

Enumeration Date: 02/07/2018
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 S HERITAGE WOODS DR
APPLETON WI
54915-1408
US

IV. Provider business mailing address

3 NEENAH CTR
NEENAH WI
54956-3070
US

V. Phone/Fax

Practice location:
  • Phone: 920-225-7875
  • Fax: 920-993-5003
Mailing address:
  • Phone: 920-830-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8247
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number197335
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: