Provider Demographics
NPI:1467923458
Name:JACKSON, BRITTANY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 BRYAN ST
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:65793-3475
Mailing Address - Country:US
Mailing Address - Phone:417-505-0778
Mailing Address - Fax:
Practice Address - Street 1:1639 BRUCE SMITH PKWY
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-7691
Practice Address - Country:US
Practice Address - Phone:417-257-1833
Practice Address - Fax:417-256-0488
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013001693164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse