Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | SP024265 | PA |
NPI | 1083380125 |
---|---|
Provider Name | Kimberly Jackson |
First Address | Pittsburgh, PA 15221-2413 |
Second Address | Pittsburgh, PA 15221-2413 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2021 |
Last Update Date | 18/08/2021 |