Provider Demographics
NPI:1669738647
Name:JACKSON, BRITTANY OREON (MBA)
Entity type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:OREON
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 DRAKE ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-1944
Mailing Address - Country:US
Mailing Address - Phone:720-551-2551
Mailing Address - Fax:
Practice Address - Street 1:4710 EAGLERIDGE CIR STE 230
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2176
Practice Address - Country:US
Practice Address - Phone:719-582-8736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO741674376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide