Individual
DERCILLA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
163 AUBREYS LN, AMHERST, VA 24521-3394
(434) 826-9138
Mailing address
163 AUBREYS LN, AMHERST, VA 24521-3394
(434) 826-9138
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
T60456749
VA
Other
Enumeration date
08/29/2018
Last updated
08/29/2018
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