Jackson, Jonathan Wesley

Jackson, Jonathan Wesley is an individual health care provider with primary practice located at 500 Lauchwood Drive , Laurinburg NC 28352-5501. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Jackson, Jonathan Wesley can be contacted via phone (910) 610-4011.

Contact Information

Primary practice address
500 Lauchwood Drive Laurinburg NC 28352-5501
Phone: (910) 610-4011
Fax: (910) 276-9412
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X APRN3271 South Carolina
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 190408 North Carolina

Profile Details

NPI number 1629273735
LBN Legal business name Jackson, Jonathan Wesley
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 19th, 2007
Last updated May 1st, 2014 - about 12 years ago

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 1629273735 NPPES
North Carolina Other 077609 CCNA CERTIFICATION
North Carolina MEDICAID 8053701 CCNA CERTIFICATION

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