Provider Demographics
NPI:1245575992
Name:JACKSON, KAREN CRUMLEY (REGISTERED NURSE)
Entity Type:Individual
Prefix:MISS
First Name:KAREN
Middle Name:CRUMLEY
Last Name:JACKSON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6780 PATANIA WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-5798
Mailing Address - Country:US
Mailing Address - Phone:904-805-0850
Mailing Address - Fax:904-805-9925
Practice Address - Street 1:6780 PATANIA WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-5798
Practice Address - Country:US
Practice Address - Phone:904-805-0850
Practice Address - Fax:904-805-9925
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3340932163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent