Provider Demographics
NPI:1518901586
Name:JACKSON, MELINDA LEA (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:LEA
Last Name:JACKSON
Suffix:
Gender:F
Credentials:APRN, FNP-BC
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Mailing Address - Street 1:MADIGAN ARMY MEDICAL CTR
Mailing Address - Street 2:BLDG 9040, JACKSON DRIVE, ATTN: DPT OF FAMILY MEDICINE
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:253-968-0770
Mailing Address - Fax:253-968-2826
Practice Address - Street 1:MADIGAN ARMY MEDICAL CTR
Practice Address - Street 2:9040 JACKSON AVE
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-0770
Practice Address - Fax:253-968-2826
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2020-01-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC098312163W00000X
WARN00165129163W00000X
WAAP30007414363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse