Provider Demographics
NPI:1750720330
Name:JACKSON, ALLISON GINETTE
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:GINETTE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CAROLINA VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29906-6790
Mailing Address - Country:US
Mailing Address - Phone:803-983-1097
Mailing Address - Fax:
Practice Address - Street 1:719 N OKATIE HWY # 170
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-8276
Practice Address - Country:US
Practice Address - Phone:843-987-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18321363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily