Individual
MRS. JULIE A JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
37 BALL PARK RD, HARLAN, KY 40831-1701
(606) 574-8409
Mailing address
37 BALL PARK RD, HARLAN, KY 40831-1701
(606) 574-8409
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4452P
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
78014487
—
KY
Enumeration date
10/24/2005
Last updated
07/22/2011
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