Individual
KAMMIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
300 THOMAS MOORE RD, MADISONVILLE, KY 42431-9564
(270) 821-4688
Mailing address
300 THOMAS MOORE RD, MADISONVILLE, KY 42431-9564
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
KY
222Q00000X
Developmental Therapist
Primary
—
KY
Other
Enumeration date
01/11/2008
Last updated
03/25/2024
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