Individual
KATHY M JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
502 W CENTRAL AVE, LA FOLLETTE, TN 37766-3400
(423) 562-1705
Mailing address
PO BOX 111, CAPE GIRARDEAU, MO 63702-0111
(423) 562-1705
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101013273
MI
Other
Enumeration date
06/16/2006
Last updated
07/08/2007
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