Individual
RICHARD THOMAS JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CSFA
Contact information
Practice address
913 N DIXIE AVE, ELIZABETHTOWN, KY 42701-2503
(270) 706-1380
Mailing address
365 LORETTO DR # DT, ELIZABETHTOWN, KY 42701-4715
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
—
—
Other
Enumeration date
09/18/2025
Last updated
10/24/2025
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