Provider Demographics
NPI:1356719264
Name:JACKSON, CHRISTA (APRN)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LILE CT STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6240
Mailing Address - Country:US
Mailing Address - Phone:501-224-5500
Mailing Address - Fax:501-224-1166
Practice Address - Street 1:1 LILE CT STE 200
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6240
Practice Address - Country:US
Practice Address - Phone:501-224-5500
Practice Address - Fax:501-224-1166
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004503363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA004503OtherARKANSAS STATE BOARD OF NURSING