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Individual

ALISIA JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APRN

Contact information

Practice address
9204 TAYLORSVILLE RD STE 217, LOUISVILLE, KY 40299-1789
(502) 709-0430
Mailing address
16605 CHESTNUT GLEN PL, LOUISVILLE, KY 40245-6121
(502) 709-0430

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
3013490
KY
363LF0000X
Family Nurse Practitioner
Primary
3013490
KY
363LF0000X
Family Nurse Practitioner
71011085A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7100720690
KY
Enumeration date
08/04/2020
Last updated
11/07/2023
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