Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 34.010920 | OH |
N | 2080P0204X | Pediatric Emergency Doctor | 34.010920 | OH |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 02005440A | IN |
NPI | 1215251558 |
---|---|
Provider Name | Ms. Meghan Drayton Jackson |
First Address | Indianapolis, IN 46206-1026 |
Second Address | Indianapolis, IN 46202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2010 |
Last Update Date | 10/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0086648 | (05) | OH |
300016003 | (05) | IN |