Individual
JENNIFER C. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
200 CLINIC DR, MADISONVILLE, KY 42431-1661
(270) 825-7200
Mailing address
200 CLINIC DR, MADISONVILLE, KY 42431-1661
(270) 825-7200
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
23527
KY
2083X0100X
Occupational Medicine Physician
23527
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000044291
BCBS PROVIDER NUMBER
—
01
—
23527
LICENSE
KY
05
—
64235278
—
KY
Enumeration date
09/17/2006
Last updated
10/08/2010
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