Provider Demographics
NPI:1184911943
Name:JACKSON, DEANNA LOUISE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:LOUISE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MISS
Other - First Name:DEANNA
Other - Middle Name:LOUISE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1458 W POPLAR AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-0631
Mailing Address - Country:US
Mailing Address - Phone:901-472-2935
Mailing Address - Fax:901-432-2439
Practice Address - Street 1:1458 W POPLAR AVE STE 200
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-0631
Practice Address - Country:US
Practice Address - Phone:901-472-2935
Practice Address - Fax:901-432-2439
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16920363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily