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NPI Code Detail

MEDICARE: ELIZABETH R JACKSON N.P.

MEDICARE: ELIZABETH R JACKSON N.P.
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
1363LF0000XFamily Nurse PractitionerR786799MS
2363LF0000XFamily Nurse Practitioner6260TN

General Provider Information

NPI Number : 1316143282
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH R JACKSON N.P.
Provider Business Mailing Address
First Line : 9025 US HIGHWAY 64
Second Line :
City : LAKELAND
State : TN
Zip : 38002-7981
Country : US
Telephone Number : 615-425-4295
Fax Number :
Provider Business Practice Location Address
First Line : 9025 US HIGHWAY 64
Second Line :
City : LAKELAND
State : TN
Zip : 38002-7981
Country : US
Telephone Number : 615-425-4295
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2007
Last Update Date : 02/04/2025

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