Individual
AMANDA L JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2139 AUBURN AVE, CINCINNATI, OH 45219-2906
(513) 585-2323
(513) 585-4893
Mailing address
237 WILLIAM HOWARD TAFT, PHYS DIV, 2ND FL, CBO2-3. ATTN: CREDENTIALING, CINCINNATI, OH 45219-2906
(513) 585-2323
(513) 585-4893
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
LP01231
RI
207VX0201X
Gynecologic Oncology Physician
Primary
35 123680
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0103881
MEDICAID
OH
01
—
201232150
MEDICAID
IN
01
—
7100301430
MEDICAID
KY
Enumeration date
05/30/2008
Last updated
02/24/2016
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