| NPI | 1114592250 |
|---|---|
| Former Name | KIERSTEN ANNE JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 8295) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 2210157) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MN 8295) | |
| Enumeration Date | 2021-05-21 |
| Last Update Date | 2021-08-03 |