Individual
DAISIONNE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1503 WURTELE AVE, LOUISVILLE, KY 40208-1042
(502) 510-1046
Mailing address
1503 WURTELE AVE, LOUISVILLE, KY 40208-1042
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/12/2025
Last updated
07/12/2025
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