Individual
DR. JESSICA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
2315 GREEN VALLEY RD STE 200, NEW ALBANY, IN 47150-4690
(502) 558-0194
Mailing address
15014 BIRCHAM RD, LOUISVILLE, KY 40245-4104
(502) 558-0194
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
00242
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200279930
—
IN
05
—
80002421
—
KY
01
—
P00696482
RAILROAD MEDICARE
KY
Enumeration date
06/08/2006
Last updated
03/04/2021
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