Provider Demographics
NPI:1508227950
Name:JACKSON, MONICA DENICE
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:DENICE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 NIXON WAY
Mailing Address - Street 2:
Mailing Address - City:LA VERGNE
Mailing Address - State:TN
Mailing Address - Zip Code:37086-3670
Mailing Address - Country:US
Mailing Address - Phone:615-947-2418
Mailing Address - Fax:
Practice Address - Street 1:1370 HAZELWOOD DR
Practice Address - Street 2:LOCATED INSIDE OF EMINENT CUTZ & STYLZ
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167
Practice Address - Country:US
Practice Address - Phone:615-947-2418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-14
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management