Individual
KRISTA L. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5000 KY ROUTE 321, SUITE 2162, PRESTONSBURG, KY 41653-9113
(606) 889-6185
(606) 889-6186
Mailing address
PO BOX 406, PRESTONSBURG, KY 41653-0406
(606) 889-6185
(606) 889-6186
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA 586
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000520426
BCBS
KY
05
—
95003141
—
KY
01
—
P00290504
RAILROAD
—
Enumeration date
01/11/2006
Last updated
05/15/2015
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