Individual
KENZIE JACKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
6700 FRANCE AVE S, SUITE 300, EDINA, MN 55435-1902
(952) 345-3000
(952) 345-6789
Mailing address
6700 FRANCE AVE S STE 300, EDINA, MN 55435-1908
(952) 345-3000
(952) 345-6789
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11821
MN
Other
Enumeration date
12/03/2014
Last updated
11/03/2020
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