MEDICARE: TOKEYSHA JOHNSON 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
1	163W00000X	Registered Nurse	1-108932	AL
2	363LP2300X	Primary Care Nurse Practitioner	1-108932	AL

General Provider Information

NPI Number	:	1316191968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOKEYSHA JOHNSON JACKSON CRNP

Provider Business Mailing Address
First Line	:	709 GRISWOLD RD
Second Line	:
City	:	FAIRFIELD
State	:	AL
Zip	:	35064-2808
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	COMMUNITY CARE BUILDING 908 20TH STREET
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35294-1047
Country	:	US
Telephone Number	:	205-934-1917
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2008
Last Update Date	:	06/04/2025

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