Individual
KAYLA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
581 EXECUTIVE PL, SUITE 500, FAYETTEVILLE, NC 28305-5702
(191) 049-3355
Mailing address
7115 HARVESTGRAIN DR, STEDMAN, NC 28391-9429
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
09/02/2016
Last updated
09/02/2016
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