Individual
DOROTHY JEAN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2906 NW VIVION RD, KANSAS CITY, MO 64150-1502
(816) 599-5050
Mailing address
6220 N CYPRESS AVE, KANSAS CITY, MO 64119-5051
(816) 679-9150
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
R8B55
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201760055
—
MO
Enumeration date
09/23/2005
Last updated
06/11/2025
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