Provider Demographics
NPI:1962972265
Name:JACKSON, JOY L
Entity type:Individual
Prefix:
First Name:JOY
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 1:1550 E STATE ROAD 44
Mailing Address - Street 2:
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331-8293
Mailing Address - Country:US
Mailing Address - Phone:765-222-1400
Mailing Address - Fax:855-855-1498
Practice Address - Street 1:1550 E STATE ROAD 44
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-8293
Practice Address - Country:US
Practice Address - Phone:765-222-1400
Practice Address - Fax:855-855-1498
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2025-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008578A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily