| NPI | 1760722144 |
|---|---|
| Former Name | BRANDI L JACKSON |
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3007706) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3007706) |
| Enumeration Date | 2013-02-22 |
| Last Update Date | 2024-06-21 |