Individual
KELLEY J JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
WHNP
Contact information
Practice address
1095 MARSHALL WAY, PLACERVILLE, CA 95667-5722
(530) 344-5470
Mailing address
1550 IRON POINT RD APT 1312, FOLSOM, CA 95630-7814
(916) 202-8490
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
95026533
CA
Other
Enumeration date
08/08/2023
Last updated
08/08/2023
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