1. Home
  2. Directory
  3. Indiana
  4. South Bend
  5. Licensed Practical Nurse
  6. NPI Profile

ANNITTA JACKSON LPN
NPI 1750077210
Licensed Practical Nurse in South Bend, IN

Active since April 17, 2023
621 MEMORIAL DR STE 402, SOUTH BEND, IN 46601(574) 400-4550(574) 400-4551 Get Directions Write a Review

NPPES record last updated: April 17, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Annitta Jackson Lpn NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ANNITTA JACKSON LPN (NPI 1750077210) is an individual licensed practical nurse in South Bend, Indiana, licensed in Indiana (27060852A) and active in the NPI registry since April 2023.

NPPES Registry Identity

NPI1750077210
Entity TypeIndividualFemale
Primary Taxonomy164W00000X
Provider Legal NameANNITTA JACKSONCredential: LPN
Location Address621 MEMORIAL DR STE 402South Bend, IN 46601-1074
Mailing Address621 Memorial Dr Ste 402South Bend, IN 46601-1074 · (574) 400-4550 · Fax (574) 400-4551
Phone(574) 400-4550
Fax(574) 400-4551
Sole ProprietorNo
Enumeration DateApril 17, 2023
NPPES CertifiedApril 17, 2023
✔ NPI 1750077210 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyLicensed Practical NurseNursing Service Providers
Taxonomy Code164W00000X
License✔ Licensed in IN · 27060852A
Definition
A licensed practical nurse with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.
621 MEMORIAL DR STE 402, South Bend, IN 46601
Open in Google Maps ↗

Other Providers at the Same Location NPPES 16

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CHRISTINE ELIZABETH COULTER MSN, FNP
Nurse Practitioner (Family)
621 MEMORIAL DR STE 402
SOUTH BEND, IN 46601
St. Joseph County (574) 400-4550
CAROLYN HORIN FNP-C
Nurse Practitioner (Family)
621 MEMORIAL DR STE 402
SOUTH BEND, IN 46601
St. Joseph County (574) 400-4550
MR. PAUL BRIAN SEXTON LCSW
Social Worker (Clinical)
621 MEMORIAL DR STE 402
SOUTH BEND, IN 46601
St. Joseph County (574) 280-8199
MARJORIE THERMIDOR DAOUD MD
Internal Medicine (Infectious Disease)
621 MEMORIAL DR STE 402, MEMORIAL HOSPITAL
SOUTH BEND, IN 46601
St. Joseph County (574) 647-2500
MICHAEL SEAN KOZAK MD
Family Medicine
621 MEMORIAL DR STE 402
SOUTH BEND, IN 46601
St. Joseph County (574) 400-4550
KAYTI LYNN BONCZYNSKI NP
Nurse Practitioner (Family)
621 MEMORIAL DR STE 402
SOUTH BEND, IN 46601
St. Joseph County (574) 400-4550
DR. MARY HOPE GRIFFIN M.D.
Pediatrics
621 MEMORIAL DR STE 402
SOUTH BEND, IN 46601
St. Joseph County (574) 400-4550
BRANDON WILLIAM ZABUKOVIC M.D.
Family Medicine
621 MEMORIAL DR STE 402
SOUTH BEND, IN 46601
St. Joseph County (574) 400-4550

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Annitta Jackson's NPI number?

The NPI number for Annitta Jackson is 1750077210. It was assigned to this individual provider in the NPPES registry on April 17, 2023.

Where is Annitta Jackson located?

Annitta Jackson practices at 621 Memorial Dr Ste 402, South Bend, IN 46601. The listed phone number is (574) 400-4550.

What is Annitta Jackson's specialty?

The primary specialty registered for this NPI is Licensed Practical Nurse with taxonomy code 164W00000X.

When was this NPI record last updated?

The NPPES record for Annitta Jackson was last updated on April 17, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.