Provider Demographics
NPI:1699928390
Name:JACKSON, MARECHA V BROWN (MSN, CNM)
Entity type:Individual
Prefix:
First Name:MARECHA
Middle Name:V BROWN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MSN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 FITZPATRICK CT
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:615-889-6126
Practice Address - Street 1:113 FITZPATRICK CT
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-3956
Practice Address - Country:US
Practice Address - Phone:615-889-6126
Practice Address - Fax:615-889-6126
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000013564367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife