MEDICARE: JUDITH AMY JACKSON FNP-C

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	363LF0000X	Family Nurse Practitioner	28173738A	IN

General Provider Information

NPI Number	:	1871961250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH AMY JACKSON FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 775383
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-5383
Country	:	US
Telephone Number	:	812-376-5315
Fax Number	:

Provider Business Practice Location Address
First Line	:	2118 25TH ST STE J
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-3240
Country	:	US
Telephone Number	:	812-372-8426
Fax Number	:	812-378-7777

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

Provider Enumeration Date	:	09/02/2015
Last Update Date	:	02/23/2026

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