Stephanie J. Jackson
Pediatrician Child Neurologist
705 Riley Hospital Dr Roc 4270
Indianapolis
, Indiana 46202-5109
Stephanie J. Jackson
Pediatrician Child Neurologist
705 Riley Hospital Dr Roc 4270
Indianapolis
, Indiana 46202-5109
(317) 278-9905
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About
Features
Specialties
- Pediatrician
- Child Neurologist
Languages spoken
- English
Location
First Address
- Stephanie J. Jackson
- Po Box 1026
- Indianapolis, IN
- Zip : 46206-1026
- Fax : (317) 278-9905
- Phone : (317) 274-1201
Second Address
- Stephanie J. Jackson
- 705 Riley Hospital Dr Roc 4270
- Indianapolis, IN
- Zip : 46202-5109
- Fax : (317) 274-7227
- Phone : (317) 274-7208
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 208000000X | Pediatrician | 125053014 | IL |
| N | 2084N0402X | Child Neurologist | 01071127 | IN |
National Provider Identifier
| NPI | 1033375043 |
|---|---|
| Provider Name | Stephanie J. Jackson |
| First Address | Indianapolis, IN 46206-1026 |
| Second Address | Indianapolis, IN 46202-5109 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 30/07/2008 |
| Last Update Date | 12/01/2021 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 201107390 | (05) | IN |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.