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General NPI Number Information
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NPI Number | 1124499124
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Entity Type | Organization
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Legal Business Name | NISHA JACKSON INC.
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Dates
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Enumeration Date | 10/15/2015
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 3265 HILLCREST PARK DR
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City | MEDFORD
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State | OR
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Zip | 97504-7657
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Country | US
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Telephone | 541-494-9355
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Fax | 541-210-8724
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Provider Business Mailing Address
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Address Line | 3236 HILLCREST PARK DR
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City | MEDFORD
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State | OR
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Zip | 97504-7657
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Country | US
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Telephone | 541-494-9355
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Fax | 541-494-0945
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MS. NISHA MARIE JACKSON
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Credential | NP
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Telephone | 541-494-9355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 086006299N7
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License Number State | OR
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