Jackson, Patricia L

Jackson, Patricia L is an individual health care provider with primary practice located at 230 W Catalpa Dr Suite D, Mishawaka IN 46545-8321. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Jackson, Patricia L can be contacted via phone (574) 257-7551.

Contact Information

Primary practice address
230 W Catalpa Dr Suite D Mishawaka IN 46545-8321
Phone: (574) 257-7551
Fax: (574) 257-7535
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 71001911A Indiana

Profile Details

NPI number 1376557702
LBN Legal business name Jackson, Patricia L
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 28th, 2006
Last updated Jul 5th, 2019 - about 7 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 1376557702 NPPES
Indiana MEDICAID 200519100

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