| NPI | 1699851931 |
|---|---|
| Other Name | PAMELA LAVERNE JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: LA AP03530) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: LA AP03530) |
| Enumeration Date | 2006-10-30 |
| Last Update Date | 2017-04-10 |