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General NPI Number Information
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NPI Number | 1205132206
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Entity Type | Individual
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Provider Name | TANYA LYNN JACKSON FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/08/2011
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 105 N CEDAR ST
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City | GLEASON
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State | TN
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Zip | 38229-7264
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Country | US
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Telephone | 731-648-5634
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Fax | 731-648-9155
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Provider Business Mailing Address
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Address Line | 205 HOSPITAL DR SUITE A
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City | MC KENZIE
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State | TN
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Zip | 38201-1649
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Country | US
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Telephone | 731-352-7907
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Fax | 731-352-4459
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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 | 15540
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License Number State | TN
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