| NPI | 1245711639 |
|---|---|
| Former Name | COURTNEY LEE JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LW0102X Nurse Practitioner, Women's Health (Licence: FL ARNP9401472) |
| Enumeration Date | 2018-08-24 |
| Last Update Date | 2019-10-03 |