Provider Demographics
NPI:1558862961
Name:JACKSON, NOELLE MORGAN
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:MORGAN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NOELLE
Other - Middle Name:ANNE
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, NP-C
Mailing Address - Street 1:1235 PLYMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37216-2211
Mailing Address - Country:US
Mailing Address - Phone:202-441-7320
Mailing Address - Fax:
Practice Address - Street 1:4230 HARDING PIKE STE 410
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2013
Practice Address - Country:US
Practice Address - Phone:615-565-6763
Practice Address - Fax:615-565-6789
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN197406163W00000X
TN23803363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse