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General NPI Number Information
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NPI Number | 1104786185
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Entity Type | Individual
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Provider Name | CRYSTAL GAIL JACKSON FNP
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Gender | Female
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Dates
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Enumeration Date | 11/13/2025
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 216 W MAIN ST
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City | STEELE
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State | MO
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Zip | 63877-1436
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Country | US
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Telephone | 573-695-2181
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 331
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City | RECTOR
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State | AR
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Zip | 72461-0331
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Country | US
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Telephone | 870-634-6304
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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 | 235288
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License Number State | AR
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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 | 2025048837
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License Number State | MO
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