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General NPI Number Information
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NPI Number | 1598855520
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Entity Type | Individual
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Provider Name | KRISTINE M JACKSON ARNP
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Gender | Female
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 220 W 7TH ST
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City | DUBUQUE
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State | IA
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Zip | 52001-2375
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Country | US
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Telephone | 563-583-6431
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Fax | 563-557-4447
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Provider Business Mailing Address
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Address Line | PO BOX 162
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City | EAST DUBUQUE
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State | IL
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Zip | 61025-0162
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Country | US
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Telephone | 815-747-3932
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Fax | 563-557-4447
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | IA F 066142
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License Number State | IA
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