Provider Demographics
NPI:1386654960
Name:JACKSON, LEE ANNE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LEE
Middle Name:ANNE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:997 OLD US HWY 70
Mailing Address - Street 2:SUITE A
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711
Mailing Address - Country:US
Mailing Address - Phone:828-669-9704
Mailing Address - Fax:828-669-7413
Practice Address - Street 1:997 OLD US HWY 70
Practice Address - Street 2:SUITE A
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711
Practice Address - Country:US
Practice Address - Phone:828-669-9704
Practice Address - Fax:828-669-7413
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC056226207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine