Individual
CHRISTIANA MARIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AT
Contact information
Practice address
10397 STATE ROUTE 155 SE, CORNING, OH 43730-9710
(740) 394-2426
Mailing address
366 RICHLAND AVE APT 5119, ATHENS, OH 45701-3262
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2782968
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2782968
ALLIED HEALTH PROFESSIONAL LIABILITY
OH
Enumeration date
08/21/2019
Last updated
08/21/2019
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