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General NPI Number Information
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NPI Number | 1013358183
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Entity Type | Individual
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Provider Name | MARKQUETTA RENEE JACKSON PMHNP
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Gender | Female
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Dates
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Enumeration Date | 07/17/2013
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 406 BLANKENBAKER PKWY STE C1
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City | DOUGLASS HILLS
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State | KY
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Zip | 40243-1881
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Country | US
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Telephone | 502-654-9575
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 PASEO VERDE PKWY STE 190
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City | HENDERSON
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State | NV
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Zip | 89052-2703
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Country | US
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Telephone | 702-589-4871
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 842906
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3008203
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 3008203
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License Number State | KY
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