Individual
LESLEY M JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
316 W 2ND ST, MOREHEAD, KY 40351-1550
(606) 784-3771
(606) 783-6847
Mailing address
316 W SECOND ST, MOREHEAD, KY 40351-1550
(606) 784-6641
(606) 783-6847
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
36869
SC
207Q00000X
Family Medicine Physician
Primary
TP037
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TP037
MEDICAL LICENSE
KY
Enumeration date
06/03/2014
Last updated
08/30/2017
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