Provider Demographics
NPI:1649888389
Name:JACKSON, MELISSA A (APNP PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:JACKSON
Suffix:
Gender:F
Credentials:APNP PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9809 S FRANKLIN DR STE 302
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8885
Mailing Address - Country:US
Mailing Address - Phone:262-269-2272
Mailing Address - Fax:
Practice Address - Street 1:9809 S FRANKLIN DR STE 302
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-8885
Practice Address - Country:US
Practice Address - Phone:262-999-3495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16250-30163WP0808X, 163WX0003X
WI10436-33363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient