Individual
MR. LARRY JACKSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
826 WARFIELD PL, LEXINGTON, KY 40505-3612
(859) 421-2250
Mailing address
826 WARFIELD PL, LEXINGTON, KY 40505-3612
(859) 421-2250
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
KY
Other
Enumeration date
03/12/2015
Last updated
03/15/2015
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