Individual
MARK JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
911 BYPASS RD BLDG A, PIKEVILLE, KY 41501-1689
(606) 430-2206
(606) 218-7506
Mailing address
PO BOX 432, PIKEVILLE, KY 41502-0432
(606) 430-2206
(606) 218-7506
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA290
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000521209
BCBS
KY
05
—
95002903
—
KY
01
—
P00164787
RAILROAD
—
01
—
P00363176
RAILROAD MEDICARE
KY
Enumeration date
01/11/2006
Last updated
06/08/2022
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