Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 61971 | TN |
N | 2080P0207X | Pediatric Hematology-Oncologist | 61971 | TN |
N | 2080P0207X | Pediatric Hematology-Oncologist | R3536 | TX |
NPI | 1053730416 |
---|---|
Provider Name | Kasey Jackson |
First Address | Nashville, TN 37204-4701 |
Second Address | Nashville, TN 37232-2608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2014 |
Last Update Date | 23/08/2021 |