| NPI | 1588293278 |
|---|---|
| Other Name | KIMBERLY DIANNE JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health (Licence: SC APN.23707) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: SC 23707) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: SC APN.23707) | |
| Enumeration Date | 2020-04-04 |
| Last Update Date | 2021-12-27 |