Individual
KYANA L JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
133 N MAIN ST, CENTERVILLE, OH 45459-4620
(937) 433-3931
Mailing address
133 N MAIN ST, CENTERVILLE, OH 45459-4620
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
OH
Other
Enumeration date
01/17/2018
Last updated
01/17/2018
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