Individual
HOLLY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1109 JONES ST, KENNETT, MO 63857-3824
(573) 359-2600
Mailing address
1109 JONES ST, KENNETT, MO 63857-3824
(573) 359-2600
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
2014030506
MO
Other
Enumeration date
02/13/2017
Last updated
02/13/2017
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