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General NPI Number Information
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NPI Number | 1023627288
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Entity Type | Individual
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Provider Name | NIKKITA JACKSON
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Gender | Female
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Dates
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Enumeration Date | 07/23/2020
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Last Update Date | 07/23/2020
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Provider Practice Location Address
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Address Line | 454 WESTCHESTER AVENUE
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City | PORT CHESTER
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State | NY
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Zip | 10573
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Country | US
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Telephone | 914-351-0650
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Fax |
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Provider Business Mailing Address
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Address Line | 454 WESTCHESTER AVENUE
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City | PORT CHESTER
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State | NY
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Zip | 10573
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Country | US
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Telephone | 914-351-0650
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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 | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | 788484
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License Number State | NY
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