Individual
KELLY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
12300 MCCRACKEN RD, GARFIELD HEIGHTS, OH 44125-2975
(412) 512-0798
Mailing address
884 MAPLE SHADE RD, CRANBERRY, PA 16319-3318
(412) 512-0798
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
08/16/2018
Last updated
08/16/2018
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