Provider Demographics
NPI:1700571502
Name:JACKSON, NSIKAK MONDAY (MD)
Entity Type:Individual
Prefix:
First Name:NSIKAK
Middle Name:MONDAY
Last Name:JACKSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 HOSPITAL DR STE 402
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-2018
Mailing Address - Country:US
Mailing Address - Phone:512-791-2452
Mailing Address - Fax:251-279-1247
Practice Address - Street 1:188 HOSPITAL DR STE 402
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2018
Practice Address - Country:US
Practice Address - Phone:512-791-2452
Practice Address - Fax:251-279-1247
Is Sole Proprietor?:No
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program