Individual
NICOLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2050 LEXINGTON RD, VERSAILLES, KY 40383-1738
(803) 384-0323
Mailing address
4585 S 375 E, OGDEN, UT 84405-5860
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
12709516-3102
UT
Other
Enumeration date
03/11/2026
Last updated
03/11/2026
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