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General NPI Number Information
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NPI Number | 1215372644
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Entity Type | Individual
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Provider Name | BRENDA LEE JACKSON RN
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Gender | Female
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Dates
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Enumeration Date | 04/29/2013
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Last Update Date | 04/29/2013
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Provider Practice Location Address
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Address Line | 530 HORNADY DR
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City | MONROEVILLE
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State | AL
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Zip | 36460-8658
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Country | US
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Telephone | 261-575-4837
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Fax | 251-575-5266
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Provider Business Mailing Address
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Address Line | 530 HORNADY DR
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City | MONROEVILLE
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State | AL
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Zip | 36460-8658
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Country | US
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Telephone | 261-575-4837
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Fax | 251-575-5266
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 1-138402
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License Number State | AL
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