Provider Demographics
NPI:1568196541
Name:JACKSON, APRIL L
Entity Type:Individual
Prefix:
First Name:APRIL
Middle Name:L
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 1:950 MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338-1389
Mailing Address - Country:US
Mailing Address - Phone:419-949-2000
Mailing Address - Fax:419-751-7322
Practice Address - Street 1:950 MEADOW DR
Practice Address - Street 2:
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-1389
Practice Address - Country:US
Practice Address - Phone:419-949-2000
Practice Address - Fax:419-751-7322
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN100872MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse