Individual
CRISTY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
161 N EAGLE CREEK DR, STE 400, LEXINGTON, KY 40509-9038
(859) 226-0031
(859) 226-0041
Mailing address
161 N EAGLE CREEK DR, STE 400, LEXINGTON, KY 40509-9038
(859) 226-0031
(859) 226-0041
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA810
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1060002
NCCPA
KY
05
—
7100042780
—
KY
Enumeration date
02/26/2008
Last updated
07/23/2014
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