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General NPI Number Information
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NPI Number | 1518901586
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Entity Type | Individual
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Provider Name | MELINDA LEA JACKSON APRN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | MADIGAN ARMY MEDICAL CTR 9040 JACKSON AVE
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City | TACOMA
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State | WA
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Zip | 98431-0001
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Country | US
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Telephone | 253-968-0770
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Fax | 253-968-2826
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Provider Business Mailing Address
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Address Line | MADIGAN ARMY MEDICAL CTR BLDG 9040, JACKSON DRIVE, ATTN: EFMP, DPT OF PEDIATRICS
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City | TACOMA
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State | WA
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Zip | 98431-0001
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Country | US
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Telephone | 253-968-0229
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Fax | 253-968-3358
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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 | 098312
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN00165129
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License Number State | WA
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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 | AP30007414
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License Number State | WA
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