Provider Demographics
NPI:1073375648
Name:JACKSON, BRITTANY EVANS (FNP-C)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:EVANS
Last Name:JACKSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4171 HOCKADAY RD
Mailing Address - Street 2:
Mailing Address - City:FOUR OAKS
Mailing Address - State:NC
Mailing Address - Zip Code:27524-7240
Mailing Address - Country:US
Mailing Address - Phone:919-901-2931
Mailing Address - Fax:
Practice Address - Street 1:1106 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-3820
Practice Address - Country:US
Practice Address - Phone:919-648-4847
Practice Address - Fax:919-648-4877
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5019508363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily