Individual
KIERRA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
118 BAYBRIDGE DR, BRUNSWICK, GA 31525-1817
(912) 689-6970
Mailing address
118 BAYBRIDGE DR, BRUNSWICK, GA 31525-1817
(912) 689-6970
Taxonomy
Speciality
Code
Description
License number
State
2279P4000X
Patient Transport Registered Respiratory Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
053324374
ID
GA
Enumeration date
12/27/2022
Last updated
12/27/2022
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