Individual
DR. JENNIFER JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2241 N 189TH CIR W, COLWICH, KS 67030-9728
(316) 789-4378
Mailing address
2241 N 189TH CIR W, COLWICH, KS 67030-9728
(316) 789-4378
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0429383
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100088840B
—
KS
05
—
200004010A
—
KS
Enumeration date
06/08/2006
Last updated
01/07/2011
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