Individual
KORY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
13685 DOCTORS WAY STE 170, FORT MYERS, FL 33912-4337
(239) 343-0629
(239) 343-0625
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-0629
(239) 343-0625
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
209014384
IL
363LG0600X
Gerontology Nurse Practitioner
Primary
APRN11024568
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
118448900
—
FL
Enumeration date
06/27/2016
Last updated
07/14/2023
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