Individual
KIRSTIE BROOKE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
41 PARK CREEK DR, GREENVILLE, SC 29605-4270
(864) 299-1600
Mailing address
258 QUAIL RD, GRAY COURT, SC 29645-4253
(864) 640-3837
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
48357
SC
Other
Enumeration date
07/31/2019
Last updated
07/31/2019
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