Individual
KAYLA BROCKWELL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1 AUDUBON PLAZA DR, LOUISVILLE, KY 40217-1318
(502) 636-7225
(502) 636-8032
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
1081653
TX
363LA2100X
Acute Care Nurse Practitioner
71009988A
IN
363LF0000X
Family Nurse Practitioner
Primary
4020267
KY
363LF0000X
Family Nurse Practitioner
71009988A
IN
Other
Enumeration date
04/20/2020
Last updated
10/16/2024
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