Provider Demographics
NPI:1194142257
Name:JACKSON, CARLA M MICHEL (RN, MSN, RNC, WHNP)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:M MICHEL
Last Name:JACKSON
Suffix:
Gender:F
Credentials:RN, MSN, RNC, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9430 BAUMGART RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47725-1378
Mailing Address - Country:US
Mailing Address - Phone:812-430-0466
Mailing Address - Fax:
Practice Address - Street 1:1033 E MOUNT PLEASANT RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47725-7149
Practice Address - Country:US
Practice Address - Phone:812-469-3706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000549A363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health