Individual
NICHOLAS JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1000 DUPONT RD, LOUISVILLE, KY 40207-4611
(502) 899-6150
Mailing address
1000 DUPONT RD, LOUISVILLE, KY 40207-4611
(502) 899-6150
(502) 891-6368
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
R4098
KY
Other
Enumeration date
03/28/2016
Last updated
08/27/2024
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