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General NPI Number Information
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NPI Number | 1497142459
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Entity Type | Individual
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Provider Name | STACEY ANN JACKSON FNP-C
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Gender | Female
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Dates
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Enumeration Date | 04/16/2015
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Last Update Date | 10/18/2017
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Provider Practice Location Address
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Address Line | 1010 CENTRAL AVENUE SUITE 2
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City | BILLINGS
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State | MT
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Zip | 59102
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Country | US
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Telephone | 406-869-1066
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Fax |
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Provider Business Mailing Address
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Address Line | 1010 CENTRAL AVENUE SUITE 2
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City | BILLINGS
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State | MT
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Zip | 59102
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Country | US
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Telephone | 406-869-1066
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 35557.1401
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 73310
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License Number State | MT
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN-100806
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License Number State | MT
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