TIERRA LEANNE JACKSON TATTOO LICENSE
NPI 1366267627
Rehabilitation Practitioner in Springfield, MO
Active since November 20, 2024
About Tierra Leanne Jackson Tattoo License NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
TIERRA LEANNE JACKSON TATTOO LICENSE (NPI 1366267627) is an individual rehabilitation practitioner in Springfield, Missouri, licensed in Missouri (2021043963) and active in the NPI registry since November 2024.
NPPES Registry Identity
NPI1366267627
Entity TypeIndividualFemale
Primary Taxonomy225400000X
Provider Legal NameTIERRA LEANNE JACKSONCredential: TATTOO LICENSE
Location Address3322 S CAMPBELL AVE # XSpringfield, MO 65807-4980
Mailing Address3322 S Campbell Ave # XSpringfield, MO 65807-4980 · (417) 771-5540
Phone(417) 771-5540
Sole ProprietorNo
Enumeration DateNovember 20, 2024
NPPES CertifiedNovember 20, 2024
✔ NPI 1366267627 is a valid, active identifier and passes the ISO check-digit test.
Specialties & Licenses 2
★ Primary SpecialtyRehabilitation PractitionerRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Taxonomy Code225400000X
License✔ Licensed in MO · 2021043963
Definition
A health care practitioner who trains or retrains individuals disabled by disease or injury to help them attain their maximum functional capacity.
Also ListedTechnician, OtherTaxonomy 247200000X · License 2021043963 (MO)
3322 S CAMPBELL AVE # X, Springfield, MO 65807
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1366267627, enumerated as an "individual" on November 20, 2024.
The provider is located at 3322 S CAMPBELL AVE # X SPRINGFIELD, MO 65807 and the phone number is (417) 771-5540.
Rehabilitation Practitioner with taxonomy code 225400000X.
