Individual provider · Type 1 NPI
Larry Randolph Jackson, REGISTERED NURSE
Psychiatric/Mental Health Registered Nurse · Columbia, SC
NPI number
1093878191
Active
Practice location
615 Rapids Rd
Columbia, SC 29212-3024
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Psychiatric/Mental Health Registered Nurse Primary | 163WP0808X | 56879 (SC) |
Psychiatric/Mental Health Registered Nurse: Definition to come...
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About NPI 1093878191
Larry Randolph Jackson, REGISTERED NURSE's National Provider Identifier is 1093878191, issued on Dec 19, 2006. The primary taxonomy on file is Psychiatric/Mental Health Registered Nurse (163WP0808X), and the practice location is in Columbia, SC. The record was last updated on Jul 8, 2007.