Provider Demographics
NPI:1952166639
Name:JACKSON, ALEXIS (CD-L, CD-PIC)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:CD-L, CD-PIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9006 PENROSE LN
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4654
Mailing Address - Country:US
Mailing Address - Phone:501-240-5140
Mailing Address - Fax:
Practice Address - Street 1:9006 PENROSE LN
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4654
Practice Address - Country:US
Practice Address - Phone:501-240-5140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-20
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula