Provider Demographics
NPI:1992854616
Name:CURTIS JACKSON, MICHELE ERIKA (PA)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:ERIKA
Last Name:CURTIS JACKSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:ERIKA
Other - Last Name:CURTIS MATTHEWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2817 REILLY ROAD MEXC COD CREDENTIALS
Mailing Address - Street 2:WOMACK ARMY MEDICAL CENTER
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310
Mailing Address - Country:US
Mailing Address - Phone:910-907-8922
Mailing Address - Fax:910-907-6069
Practice Address - Street 1:2817 REILLY ROAD MEXC COD CREDENTIALS
Practice Address - Street 2:WOMACK ARMY MEDICAL CENTER
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310
Practice Address - Country:US
Practice Address - Phone:910-907-8922
Practice Address - Fax:910-907-6069
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant