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General NPI Number Information
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NPI Number | 1073375648
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Entity Type | Individual
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Provider Name | BRITTANY EVANS JACKSON FNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/29/2024
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 514 N BRIGHTLEAF BLVD STE 1100
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City | SMITHFIELD
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State | NC
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Zip | 27577-4487
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Country | US
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Telephone | 919-989-2192
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Fax | 919-934-0006
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Provider Business Mailing Address
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Address Line | 4171 HOCKADAY RD
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City | FOUR OAKS
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State | NC
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Zip | 27524-7240
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Country | US
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Telephone | 919-901-2931
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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 | 5019508
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License Number State | NC
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