Provider Demographics
NPI:1285076059
Name:JACKSON, ROSEMARY ANN (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:ROSEMARY
Middle Name:ANN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 FAUQUIER PL
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-2005
Mailing Address - Country:US
Mailing Address - Phone:757-874-6449
Mailing Address - Fax:
Practice Address - Street 1:576 JEFFERSON AVE.
Practice Address - Street 2:
Practice Address - City:FORT EUSTIS
Practice Address - State:VA
Practice Address - Zip Code:23604-5548
Practice Address - Country:US
Practice Address - Phone:757-314-7500
Practice Address - Fax:757-314-7854
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA24171010363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health