Carolyn A Jackson, NP
Individual provider Active NPI Nurse Practitioner · Woodsfield, OH
NPI 1023063823 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1023063823
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- NP 01675 (OH)
- Practice address
- 37984 Airport Rd
Woodsfield, OH 43793-9247 - Phone
- (740) 472-0757
- Fax
- (740) 472-0283
- NPI assigned
- May 23, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NP 01675 | OH | MD | Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | NP 01675 | OH | Yes |
Addresses
Primary practice location
37984 Airport Rd
Woodsfield, OH 43793-9247
Mailing address
PO Box 658
Woodsfield, OH 43793-0658
Phone (740) 472-5167
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| JA2027601 | Other | OH | MEDICARE FQHC PIN |
Other providers in Woodsfield, OH
- Brandi Kay Hickenbottom
- Elizabeth Hull-Frye
- Jacqueline Viola Hupp
- Michelle Anne Husek
- Interim Healthcare of SE Ohio Inc
- Jason R Just
- Krista Jones
- Tiffany Marie Jones
- Jason R Just
- Jacqulyn Krider
All providers in Woodsfield, OH · Nurse Practitioner in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.