Provider Demographics
NPI:1184124182
Name:JACKSON, EMILY ANN (B-C NNP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:B-C NNP
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ANN
Other - Last Name:DEVERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8520 E KEMPER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-2479
Mailing Address - Country:US
Mailing Address - Phone:513-321-1753
Mailing Address - Fax:
Practice Address - Street 1:8520 E KEMPER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249
Practice Address - Country:US
Practice Address - Phone:513-321-1753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.022457363L00000X, 363LP0808X
IN71012249A363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal