Jackson, Randall

Jackson, Randall is an individual health care provider with primary practice located at 215 Marion Ave , Mccomb MS 39648-2705. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Acute Care. Physician Assistants & Advanced Practice Nursing Providers / Acute Care is his primary health care specialty. Jackson, Randall can be contacted via phone (601) 249-5500.

Contact Information

Primary practice address
215 Marion Ave Mccomb MS 39648-2705
Phone: (601) 249-5500
Fax: (601) 249-1173
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X R878547 Mississippi
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X 878547 Mississippi

Profile Details

NPI number 1144614165
LBN Legal business name Jackson, Randall
Credentials Certified Family Nurse Practitioner (CFNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 27th, 2015
Last updated May 2nd, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1144614165 NPPES
Mississippi MEDICAID 05435530

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