Individual provider · NPI-1
Stephanie D Jackson, RN
Registered Nurse · Loganville, GA
NPI number1902559784
StatusActive
Last updated in NPPESFeb 1, 2022
Details
- NPI
- 1902559784
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Stephanie D Jackson
- Credential
- RN
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Feb 1, 2022
- Certification date
- Feb 1, 2022
- Last updated
- Feb 1, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 163W00000X | Registered Nurse | RN210155 | GA | Yes |
| 163WC0400X | Registered Nurse, Case Management | RN210155 | GA | |
| 163WE0900X | Registered Nurse, Enterostomal Therapy | RN210155 | GA | |
| 163WH0200X | Registered Nurse, Home Health | RN | GA | |
| 163WC1500X | Registered Nurse, Community Health | RN | GA | |
| 163WD0400X | Registered Nurse, Diabetes Educator | RN210155 | GA | |
| 163WA2000X | Registered Nurse, Administrator | Rn210155 | GA | |
| 163WH1000X | Registered Nurse, Hospice | RN | GA | |
| 163WI0500X | Registered Nurse, Infusion Therapy | RN | GA | |
| 163WN1003X | Registered Nurse, Nutrition Support | RN210155 | GA | |
| 163WP0000X | Registered Nurse, Pain Management | RN210155 | GA | |
| 163WW0000X | Registered Nurse, Wound Care | RN210155 | GA | |
| 163WX0800X | Registered Nurse, Orthopedic | RN210155 | GA | |
| 163WX1500X | Registered Nurse, Ostomy Care | RN210155 | GA |
Other names
- Stephanie Denise Ray (Former Name)
Practice location
4605 Chestnut Oak StLoganville, GA 30052-9408
Phone 423-227-8576
Mailing address
4605 Chestnut Oak StLoganville, GA 30052-9408
Phone 423-227-8576
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