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Individual

MR. JACKSON WALTER SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
780 ROSE ST, LEXINGTON, KY 40536-0001
(859) 323-6161
Mailing address
780 ROSE ST, LEXINGTON, KY 40536-0001
(859) 323-6161

Taxonomy

Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary

Other

Enumeration date
04/14/2025
Last updated
04/14/2025
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