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General NPI Number Information
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NPI Number | 1427778471
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Entity Type | Individual
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Provider Name | PATRICIA JACKSON DNP, CRNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/30/2022
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 500 N KNOX ST
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City | TROY
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State | AL
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Zip | 36081-2800
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Country | US
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Telephone | 334-722-1413
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Fax |
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Provider Business Mailing Address
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Address Line | 500 N KNOX ST
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City | TROY
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State | AL
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Zip | 36081-2800
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Country | US
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Telephone | 334-372-2162
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 1-128321
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License Number State | AL
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