Individual
MISS KELLY NICOLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2085 N 120TH ST, SUITE D8, OMAHA, NE 68164-3479
(402) 445-4335
(402) 445-6162
Mailing address
8464 ORCHARD AVE, OMAHA, NE 68127-2606
(402) 960-9964
(402) 445-6162
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
NE733
NE
Other
Enumeration date
08/11/2008
Last updated
08/11/2008
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