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Individual

KIMBERLY ANN JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
N.P.

Contact information

Practice address
813 E 4TH ST, STE A, MOUNT VERNON, IN 47620-2012
(812) 838-2139
(812) 838-9214
Mailing address
PO BOX 1510, EVANSVILLE, IN 47706-1510
(812) 838-2139
(812) 838-9214

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71003090A
IN
363LF0000X
Family Nurse Practitioner
71003090A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200976080
IN
Enumeration date
11/02/2009
Last updated
01/03/2013
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