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NPI Code Detail

MEDICARE: PAULA DEAUN JACKSON CRNP

MEDICARE: PAULA DEAUN 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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerSP030377PA
2363LC1500XCommunity Health Nurse Practitioner26NJ00025500NJ
3363L00000XNurse PractitionerTP004745DPA

General Provider Information

NPI Number : 1801877907
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAULA DEAUN JACKSON CRNP
Provider Business Mailing Address
First Line : PO BOX 13579
Second Line :
City : READING
State : PA
Zip : 19612-3579
Country : US
Telephone Number : 484-628-1324
Fax Number :
Provider Business Practice Location Address
First Line : 160 E ERIE AVE STE 3311
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19134-1011
Country : US
Telephone Number : 215-427-3803
Fax Number : 215-492-8119
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2005
Last Update Date : 12/15/2025

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