Provider Demographics
NPI:1932950912
Name:JACKSON, MARYAH
Entity Type:Individual
Prefix:
First Name:MARYAH
Middle Name:
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 1:1912 GREEN MOUNTAIN DR APT 427
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-4028
Mailing Address - Country:US
Mailing Address - Phone:501-297-1781
Mailing Address - Fax:
Practice Address - Street 1:1912 GREEN MOUNTAIN DR APT 427
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-4028
Practice Address - Country:US
Practice Address - Phone:501-297-1781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula