Individual
KENNETH WILLIAM JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2 TRILLIUM WAY STE 106, CORBIN, KY 40701-8426
(606) 526-4070
(606) 526-4072
Mailing address
2 TRILLIUM WAY STE 106, CORBIN, KY 40701-8426
(606) 526-4070
(606) 526-4072
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
TC075
KY
Other
Enumeration date
01/29/2024
Last updated
10/11/2024
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