Individual
DESYRE KIMBERLY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
734 POCAHONTAS PL, HAMPTON, VA 23661-2434
(757) 975-3813
Mailing address
734 POCAHONTAS PL, HAMPTON, VA 23661-2434
(757) 975-3813
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
VA
Other
Enumeration date
06/19/2020
Last updated
06/19/2020
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