Provider Demographics
NPI:1720423007
Name:JACKSON, FRANCINE (ANP-BC)
Entity Type:Individual
Prefix:
First Name:FRANCINE
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4483 DUNCAN AVE
Mailing Address - Street 2:MAILSTOP 90-36-697
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1111
Mailing Address - Country:US
Mailing Address - Phone:314-454-7055
Mailing Address - Fax:
Practice Address - Street 1:4483 DUNCAN AVE
Practice Address - Street 2:MAILSTOP 90-36-697
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1111
Practice Address - Country:US
Practice Address - Phone:314-454-7055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013010844363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health