Jackson, Stephanie J.

Jackson, Stephanie J. is an individual health care provider with primary practice located at 705 Riley Hospital Dr Roc 4270, Indianapolis IN 46202-5109. She recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Neurology with Special Qualifications in Child Neurology, Allopathic & Osteopathic Physicians / Sleep Medicine. Allopathic & Osteopathic Physicians / Sleep Medicine is her primary health care specialty. Jackson, Stephanie J. can be contacted via phone (317) 274-7208.

Contact Information

Primary practice address
705 Riley Hospital Dr Roc 4270 Indianapolis IN 46202-5109
Phone: (317) 274-7208
Fax: (317) 274-7227
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 125053014 Illinois
Allopathic & Osteopathic Physicians / Neurology with Special Qualifications in Child Neurology 2084N0402X 01071127 Indiana
Allopathic & Osteopathic Physicians / Sleep Medicine 2080S0012X 01071127A Indiana

Profile Details

NPI number 1033375043
LBN Legal business name Jackson, Stephanie J.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 30th, 2008
Last updated Jan 12th, 2021 - about 5 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 1033375043 NPPES
Indiana MEDICAID 201107390

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