Individual
MARY ANNE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2401 GILLHAM RD, KANSAS CITY, MO 64108-4619
(816) 234-3061
(816) 346-1328
Mailing address
2401 GILLHAM RD, KANSAS CITY, MO 64108-4619
(816) 234-3000
Taxonomy
Speciality
Code
Description
License number
State
2080P0208X
Pediatric Infectious Diseases Physician
Primary
R8D24
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100204990A
—
KS
05
—
202250304
—
MO
Enumeration date
05/12/2006
Last updated
06/22/2011
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