Individual
DR. KIMBERLEY EVELYN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
902 LAKEVIEW AVE, PUEBLO, CO 81004-3597
(719) 557-5855
(719) 557-4690
Mailing address
902 LAKEVIEW AVE, PUEBLO, CO 81004-3597
(719) 557-5855
(719) 557-4690
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
OS014960
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50533
COLORADO LICENSE
CO
01
—
OS014960
PENNSYLVANIA OSTEOPATHIC MEDICAL BOARD
PA
Enumeration date
07/22/2008
Last updated
09/16/2011
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