Individual
JACLYN M ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7300 TURFWAY RD, FLORENCE, KY 41042-1375
(859) 212-5025
(859) 212-4432
Mailing address
PO BOX 635283, CINCINNATI, OH 45263-5283
(859) 212-5025
(859) 212-4432
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
35.089541
OH
208000000X
Pediatrics Physician
Primary
41045
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0056986
—
OH
05
—
200994640
—
IN
01
—
35.089541
OH LICENSE
OH
01
—
41045
KY LICENSE
KY
05
—
7100016160
—
KY
Enumeration date
05/10/2007
Last updated
05/14/2024
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