Provider Demographics
NPI:1003142332
Name:JACKSON, BETH LYNNA (DOULA)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:LYNNA
Last Name:JACKSON
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3802 KINGMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50311-3608
Mailing Address - Country:US
Mailing Address - Phone:515-274-6696
Mailing Address - Fax:
Practice Address - Street 1:3802 KINGMAN BLVD
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50311-3608
Practice Address - Country:US
Practice Address - Phone:515-274-6696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula