TIERRA JACKSON, TATTOO LICENSE

Rehabilitation Practitioner

Active Individual
NPI: 1366267627

Practice Address

3322 S CAMPBELL AVE # X
Springfield, MO 65807

Phone: (417) 771-5540

Specialties

Specialty Code Primary License
Rehabilitation Practitioner 225400000X Yes 2021043963 (MO)
Technician, Other 247200000X No 2021043963 (MO)

Frequently Asked Questions

NPI 1366267627 is the National Provider Identifier for TIERRA JACKSON, TATTOO LICENSE, a Rehabilitation Practitioner provider located in Springfield, MO. This NPI was enumerated on November 20, 2024.
TIERRA JACKSON, TATTOO LICENSE practices at 3322 S CAMPBELL AVE # X, Springfield, MO 65807.

Quick Facts

NPI
1366267627
Type
Individual
Enumerated
Nov 20, 2024
Last Updated
Nov 20, 2024

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