| NPI | 1427686765 |
|---|---|
| Former Name | KATY JO JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: OK 41751) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 94-10215) |
| 207RG0100X Internal Medicine Gastroenterology (Licence: KS 94-10215) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2023-08-13 |