Provider Demographics
NPI:1457195836
Name:JACKSON, LINDA ANN (BSN RN)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:ANN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:222 COUNTY ROAD 3226
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-8255
Mailing Address - Country:US
Mailing Address - Phone:479-223-7403
Mailing Address - Fax:
Practice Address - Street 1:222 COUNTY ROAD 3226
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-8255
Practice Address - Country:US
Practice Address - Phone:479-223-7403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR106663163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice