Individual
MISS CAROLINE MICHELLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
272 LONDON MOUNTAIN VIEW DR, LONDON, KY 40741-6601
(606) 877-2850
Mailing address
272 LONDON MOUNTAIN VIEW DR, LONDON, KY 40741-6601
(606) 877-2850
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2760
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100781390
—
KY
Enumeration date
11/01/2021
Last updated
10/21/2025
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