Provider Demographics
NPI:1508623943
Name:CAMPBELL JACKSON, JENNIFER A
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:CAMPBELL JACKSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 BIANCA RD
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-3507
Mailing Address - Country:US
Mailing Address - Phone:808-854-6693
Mailing Address - Fax:
Practice Address - Street 1:95 TREMONT ST STE 2
Practice Address - Street 2:
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-4738
Practice Address - Country:US
Practice Address - Phone:617-213-0624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2325032363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health