Provider Demographics
NPI:1235661398
Name:JACKSON, ALNITA (NP)
Entity Type:Individual
Prefix:
First Name:ALNITA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ALNITA
Other - Middle Name:
Other - Last Name:LARKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:114 TIMBERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-5640
Mailing Address - Country:US
Mailing Address - Phone:910-709-3042
Mailing Address - Fax:
Practice Address - Street 1:114 TIMBERIDGE DR
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-5640
Practice Address - Country:US
Practice Address - Phone:910-709-3042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009383363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5009383OtherNURSE PRACTITONER