Provider Demographics
NPI:1790490191
Name:JACKSON HEALTH, PLLC
Entity Type:Organization
Organization Name:JACKSON HEALTH, PLLC
Other - Org Name:JACKSON HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FNP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:218-282-0457
Mailing Address - Street 1:14878 E HARMONY DR
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-4849
Mailing Address - Country:US
Mailing Address - Phone:218-282-0457
Mailing Address - Fax:
Practice Address - Street 1:14878 E HARMONY DR
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-4849
Practice Address - Country:US
Practice Address - Phone:218-282-0457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-19
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty