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General NPI Number Information
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NPI Number | 1821606658
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Entity Type | Individual
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Provider Name | NEKIA GENEVA JACKSON FNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/17/2020
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 2 EMBARCADERO CTR LBBY LEVEL
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City | SAN FRANCISCO
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State | CA
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Zip | 94111-3823
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Country | US
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Telephone | 888-663-6331
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Fax |
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Provider Business Mailing Address
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Address Line | 124 OSIER DR
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City | MCDONOUGH
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State | GA
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Zip | 30252-8964
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Country | US
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Telephone | 470-774-6162
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95020194
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN264287
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License Number State | GA
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