| NPI | 1730514100 |
|---|---|
| Former Name | CHRISTINA ALISE JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OH 50.005058RX) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: KY TC220) |
| Enumeration Date | 2013-09-04 |
| Last Update Date | 2019-05-28 |