Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mrs. Illeana Elizabeth Jackson, LMT/MLD

Individual provider Massage Therapist · NPI 1790636777

Mrs. Illeana Elizabeth Jackson, LMT/MLD is a Massage Therapist in Fayetteville, North Carolina. Practices as a sole proprietor. Licensed in North Carolina.

Licensed in
NC
In the registry since
2026

Practice location Address checks out

6682 Vaughn Rd
Fayetteville, NC 28304-6009
Phone: (910) 885-5396
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Massage Therapist (primary) Taxonomy 225700000X · Licence 17654 (NC)

Record details

NPI number1790636777
Entity typeIndividual (Type 1)
GenderFemale
Credentials LMT/MLD
Sole proprietorYes
NPI enumeratedFebruary 5, 2026
Last updated in NPPESFebruary 5, 2026
Certification dateFebruary 5, 2026

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