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General NPI Number Information
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NPI Number | 1649888389
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Entity Type | Individual
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Provider Name | MELISSA A JACKSON APNP PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/20/2020
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 9809 S FRANKLIN DR STE 302
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City | FRANKLIN
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State | WI
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Zip | 53132-8885
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Country | US
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Telephone | 262-999-3495
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Fax |
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Provider Business Mailing Address
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Address Line | 9809 S FRANKLIN DR STE 302
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City | FRANKLIN
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State | WI
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Zip | 53132-8885
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Country | US
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Telephone | 262-269-2272
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 16250-30
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 163WX0003X
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Taxonomy Name | Inpatient Obstetric Registered Nurse
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License Number | 16250-30
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 10436-33
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License Number State | WI
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