Individual
DOMINIQUE L. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMSC, PA-C
Contact information
Practice address
812 W KING ST, KINGS MOUNTAIN, NC 28086-2748
(704) 739-5456
(704) 739-5271
Mailing address
200 E 2ND AVE, GASTONIA, NC 28052-4358
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-14318
NC
Other
Enumeration date
02/06/2024
Last updated
11/11/2025
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