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NPI Code Detail

MEDICARE: MELINDA LOUISE JACKSON CRNP

MEDICARE: MELINDA LOUISE JACKSON CRNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse1-117801AL
2363LN0005XCritical Care Neonatal Nurse Practitioner1-117801AL
3363LN0000XNeonatal Nurse Practitioner1-117801AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1NAOTHERNA

General Provider Information

NPI Number : 1225673445
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELINDA LOUISE JACKSON CRNP
Provider Business Mailing Address
First Line : 400 TAYLOR RD
Second Line :
City : MONTGOMERY
State : AL
Zip : 36117-3511
Country : US
Telephone Number : 205-335-7683
Fax Number :
Provider Business Practice Location Address
First Line : 400 TAYLOR RD
Second Line :
City : MONTGOMERY
State : AL
Zip : 36117-3511
Country : US
Telephone Number : 205-335-7683
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2019
Last Update Date : 01/19/2023

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