MEDICARE: CLAUDIA JACKSON

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	5021321	NC

General Provider Information

NPI Number	:	1619785284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAUDIA JACKSON

Provider Business Mailing Address
First Line	:	921 TOWN CENTRE BLVD UNIT 402
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27520-2181
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2902 CENTRAL HEIGHTS RD STE A-C
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-6513
Country	:	US
Telephone Number	:	919-679-2600
Fax Number	:

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

Provider Enumeration Date	:	12/27/2024
Last Update Date	:	10/27/2025

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