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NPI Profile for KRISTIE L JACKSON in BLACKSBURG, VA.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Family |
363LF0000X | 50 | Nurse Practitioner |
| NPI # | 1053407817 |
|
| Status | Active | |
| Credentials | NP (Nurse Practitioner) | |
| Entity | Individual | |
| Enumeration date | 10/05/2006 | |
| Last updated | 07/08/2007 - About 19 years ago | |
| Sole proprietor 1 | Yes | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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KRISTIE L JACKSON
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KRISTIE L JACKSON, NP