Individual
MRS. YOLANDA H. JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
512 THOMAS ST., BOYLE, MS 38730
(662) 545-4867
Mailing address
512 THOMAS ST., BOYLE, MS 38730
(663) 545-4867
Taxonomy
Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38730
—
MS
Enumeration date
05/10/2013
Last updated
05/10/2013
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