Mrs. Kimberly Ann Jackson
Nurse Practitioner - Women's Health
215 E Main St
Providence
, Kentucky 42450-1261
Mrs. Kimberly Ann Jackson
Nurse Practitioner - Women's Health
215 E Main St
Providence
, Kentucky 42450-1261
(270) 667-9065
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About
Features
Specialties
- Nurse Practitioner - Women's Health
Languages spoken
- English
Location
First Address
- Mrs. Kimberly Ann Jackson
- Po Box 37
- Providence, KY
- Zip : 42450-0037
- Fax : (270) 667-9065
- Phone : (270) 667-7017
Second Address
- Mrs. Kimberly Ann Jackson
- 215 E Main St
- Providence, KY
- Zip : 42450-1261
- Fax : (270) 667-9065
- Phone : (270) 667-7017
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 363LW0102X | Nurse Practitioner - Women's Health | 1086349 | KY |
National Provider Identifier
| NPI | 1023135126 |
|---|---|
| Provider Name | Mrs. Kimberly Ann Jackson |
| First Address | Providence, KY 42450-0037 |
| Second Address | Providence, KY 42450-1261 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 23/03/2007 |
| Last Update Date | 02/03/2018 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 7100128660 | (05) | KY |
| K185610 | MEDICARE - RHCA (01) | KY |
| P27287 | (02) | KY |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.