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General NPI Number Information
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NPI Number | 1316191968
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Entity Type | Individual
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Provider Name | TOKEYSHA JOHNSON JACKSON CRNP
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Gender | Female
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Dates
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Enumeration Date | 11/10/2008
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | COMMUNITY CARE BUILDING 908 20TH STREET
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City | BIRMINGHAM
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State | AL
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Zip | 35294-1047
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Country | US
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Telephone | 205-934-1917
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Fax |
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Provider Business Mailing Address
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Address Line | 709 GRISWOLD RD
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City | FAIRFIELD
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State | AL
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Zip | 35064-2808
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Country | US
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Telephone |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1-108932
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 1-108932
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License Number State | AL
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