Jackson, Glenda Elizabeth

Jackson, Glenda Elizabeth is an sole proprietor health care provider with primary practice located at 12225 71St St , Kenosha WI 53142-7320. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health. Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health is her primary health care specialty. Jackson, Glenda Elizabeth can be contacted via phone (877) 666-7223.

Contact Information

Primary practice address
12225 71St St Kenosha WI 53142-7320
Phone: (877) 666-7223
Fax: (262) 948-4871
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 16452 Wisconsin
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 16452-33 Wisconsin

Profile Details

NPI number 1205291572
LBN Legal business name Jackson, Glenda Elizabeth
Credentials Registered Nurse (RN)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 30th, 2015
Last updated Jun 25th, 2025 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1205291572 NPPES
Wisconsin MEDICAID 100310731
Wisconsin MEDICAID 100310882

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