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General NPI Number Information
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NPI Number | 1780561118
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Entity Type | Organization
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Legal Business Name | JACKSON FAMILY MEDICINE AND WELLNESS CENTER INC.
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Dates
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Enumeration Date | 08/18/2025
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Last Update Date | 02/15/2026
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Provider Practice Location Address
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Address Line | 4764 N NC 16 BUSINESS HWY
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City | DENVER
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State | NC
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Zip | 28037-7915
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Country | US
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Telephone | 980-222-7004
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Fax | 980-375-1173
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Provider Business Mailing Address
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Address Line | 4764 N NC 16 BUSINESS HWY
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City | DENVER
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State | NC
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Zip | 28037-7915
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Country | US
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Telephone | 980-222-7004
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Fax | 980-375-1173
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KIMBERLY JACKSON
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Credential | DNP, FNP-BC
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Telephone | 704-320-5347
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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 |
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License Number State |
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