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NPI Code Detail

MEDICARE: MELISSA A JACKSON APNP PMHNP-BC

MEDICARE: MELISSA A JACKSON APNP PMHNP-BC
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
1163WP0808XPsychiatric/Mental Health Registered Nurse16250-30WI
2163WX0003XInpatient Obstetric Registered Nurse16250-30WI
3363LP0808XPsychiatric/Mental Health Nurse Practitioner10436-33WI

General Provider Information

NPI Number : 1649888389
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA A JACKSON APNP PMHNP-BC
Provider Business Mailing Address
First Line : 9809 S FRANKLIN DR STE 302
Second Line :
City : FRANKLIN
State : WI
Zip : 53132-8885
Country : US
Telephone Number : 262-269-2272
Fax Number :
Provider Business Practice Location Address
First Line : 9809 S FRANKLIN DR STE 302
Second Line :
City : FRANKLIN
State : WI
Zip : 53132-8885
Country : US
Telephone Number : 262-999-3495
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2020
Last Update Date : 10/07/2024

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