Provider Demographics
NPI:1043521289
Name:JACKSON, BRITNEY M (APRN)
Entity type:Individual
Prefix:MRS
First Name:BRITNEY
Middle Name:M
Last Name:JACKSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:BRITNEY
Other - Middle Name:M
Other - Last Name:JESSIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 PHYSICIANS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-1299
Mailing Address - Country:US
Mailing Address - Phone:270-629-6722
Mailing Address - Fax:270-629-6723
Practice Address - Street 1:102 PHYSICIANS BLVD STE B
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-1299
Practice Address - Country:US
Practice Address - Phone:270-629-6722
Practice Address - Fax:270-629-6723
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006632363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100144360Medicaid
KYK040760Medicare PIN