Individual
EMILY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
901 S 4TH ST, LOUISVILLE, KY 40203-3205
(502) 289-5519
Mailing address
11617 NANSEMOND DR APT A, LOUISVILLE, KY 40245-1723
(901) 493-1824
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/08/2022
Last updated
06/08/2022
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