KELLY JACKSON JOHNSON

HERRIN, IL
NPI1235412982
Former NameKELLY ELIZABETH JACKSON
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: KY  PA1637)
Enumeration Date2011-09-20
Last Update Date2017-02-23
Business Address
Mrs. KELLY JACKSON JOHNSON PA-C
510 LINCOLN DR
HERRIN, IL 62948-6334
Phone number: 618-997-6800
Mailing Address
Mrs. KELLY JACKSON JOHNSON PA-C
4787 ALBEN BARKLEY DR SUITE 103
PADUCAH, KY 42001-6789
Phone number: 270-442-9461