Individual
CAROL DIANE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
712 FIRST TERRACE, #200, LANSING, KS 66043-1735
(913) 727-6000
(913) 351-1346
Mailing address
8929 PARALLEL PARKWAY, PMG-PHYSICIAN CREDENTIALING ATTN KATHLEEN, KANSAS CITY, KS 66112-1689
(913) 596-3893
(785) 270-7646
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
53-45399-121
KS
Other
Enumeration date
03/09/2006
Last updated
03/24/2016
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