Jackson, Katrina Margaret

Jackson, Katrina Margaret is an individual health care provider with primary practice located at 1580 Beam Ave , Maplewood MN 55109-1127. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Jackson, Katrina Margaret can be contacted via phone (651) 779-7978.

Contact Information

Primary practice address
1580 Beam Ave Maplewood MN 55109-1127
Phone: (651) 779-7978
Fax: (651) 779-7656
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 4704285871 Michigan
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 11676 Ohio
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 2397795 Minnesota

Profile Details

NPI number 1588979306
LBN Legal business name Jackson, Katrina Margaret
Credentials Certified Nurse Practitioner (CNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 17th, 2010
Last updated Nov 21st, 2017 - about 9 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 1588979306 NPPES
Indiana MEDICAID 201010130
Indiana MEDICAID 7100132960
Indiana MEDICAID 3080713

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