Provider Demographics
NPI:1982743274
Name:JACKSON, EARLINE (LPN CMLDT LMT)
Entity type:Individual
Prefix:MRS
First Name:EARLINE
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LPN CMLDT LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2631 BRIGHTON BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-7978
Mailing Address - Country:US
Mailing Address - Phone:919-677-0767
Mailing Address - Fax:919-322-0976
Practice Address - Street 1:2631 BRIGHTON BLUFF DR
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27539-7978
Practice Address - Country:US
Practice Address - Phone:919-677-0767
Practice Address - Fax:919-322-0976
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC71590164W00000X
NC8517174400000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse