Individual
ELIZABETH CONNER JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
740 S LIMESTONE, LEXINGTON, KY 40536-0001
(859) 323-5481
Mailing address
3333 BURNET AVE, UROLOGY, CCHMC, CINCINNATI, OH 45229-3026
(513) 636-4975
(513) 636-1431
Taxonomy
Speciality
Code
Description
License number
State
2080P0210X
Pediatric Nephrology Physician
23556
KY
2080P0210X
Pediatric Nephrology Physician
Primary
35. 082704
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64235567
—
KY
Enumeration date
07/20/2006
Last updated
10/31/2011
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