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1235412982
KELLY JACKSON JOHNSON
HERRIN, IL
NPI
1235412982
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Former Name
KELLY ELIZABETH JACKSON
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: KY PA1637)
Enumeration Date
2011-09-20
Last Update Date
2017-02-23
Business Address
Mrs. KELLY JACKSON JOHNSON PA-C
510 LINCOLN DR
HERRIN, IL 62948-6334
Phone number: 618-997-6800
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Mailing Address
Mrs. KELLY JACKSON JOHNSON PA-C
4787 ALBEN BARKLEY DR SUITE 103
PADUCAH, KY 42001-6789
Phone number: 270-442-9461
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