Individual
JACKIE LYNN CANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
11226 PRAIRIE RD, JEFFERSONVILLE, OH 43128-9713
(740) 463-2526
Mailing address
11226 PRAIRIE RD, JEFFERSONVILLE, OH 43128-9713
(740) 463-2526
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
P.N 144265
OH
Other
Enumeration date
07/26/2012
Last updated
07/26/2012
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