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Jessie
Criswell
CRNP
Contract Details
Jackson Medical Center
Facility name
Provider ID
P000000001
NPI
1992244206
Tax ID
208057478
Effective Date
9/30/2020
Last Updated
10/8/2020
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
M
Exhibit ID
AM_462
Exhibit Attachment
Location Details
Address
220 Hospital Drive
Jackson, AL 36545
United States
Phone
251-246-9021
(
Phone
)
Billing Details
Address
220 Hospital Drive
Jackson, AL 36545
Billing Phone
251-246-9021
Specialty Type
Nurse Practitioner
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Address