Individual
MR. CLEVE EDWARD JACKSON II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN FNP-C
Contact information
Practice address
23 A ST STE B, LOUISA, KY 41230-6001
(606) 638-4504
Mailing address
2810 FULLERS RIDGE RD, LOUISA, KY 41230-6235
(606) 615-3562
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4051767
KY
Other
Enumeration date
02/04/2026
Last updated
02/04/2026
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