Carla Marie Jackson, APRN
Nurse Practitioner, Primary Care in Fulton, AR. Individual provider (NPI-1).
NPI number1710694971
StatusActive
Last updated in NPPESOct 27, 2022
Details
- NPI
- 1710694971
- Entity type
- Individual (NPI-1)
- Name
- Carla Marie Jackson
- Credential
- APRN
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Oct 27, 2022
- Certification date
- Oct 27, 2022
- Last updated
- Oct 27, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP2300X | Nurse Practitioner, Primary Care | 1036336 | TX | Yes |
| 261QI0500X | Clinic/Center, Infusion Therapy | 1036336 | TX | |
| 261QP2300X | Clinic/Center, Primary Care | 1036336 | TX |
Practice location
4903 Highway 67 WFulton, AR 71838-9033
Phone 903-244-5368
Mailing address
Po Box 7395Texarkana, TX 75505-7395
Phone 903-244-5368
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