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General NPI Number Information
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NPI Number | 1578299871
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Entity Type | Individual
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Provider Name | KATHERINE ELIZABETH JACKSON DNP, CPNP-PC
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Gender | Female
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Dates
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Enumeration Date | 07/28/2022
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 1238 DANTIGNAC ST
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City | AUGUSTA
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State | GA
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Zip | 30901-2788
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Country | US
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Telephone | 706-922-0600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 31164
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City | AUGUSTA
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State | GA
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Zip | 30903-2964
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Country | US
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Telephone | 706-922-0600
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | RN184943
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License Number State | GA
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