Organization
JESSICA S JACKSON DPM PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA JACKSON DPM (DPM)
(502) 558-0194
Entity
Organization
Contact information
Practice address
15014 BIRCHAM RD, LOUISVILLE, KY 40245-4104
(502) 558-0194
Mailing address
15014 BIRCHAM RD, LOUISVILLE, KY 40245-4104
(502) 558-0194
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
00242
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201083640A
—
IN
05
—
7100071060
—
KY
01
—
DO6474
RAILROAD MEDICARE
KY
Enumeration date
11/25/2008
Last updated
01/20/2021
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