| NPI | 1831487644 |
|---|---|
| Former Name | KAYA JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 079129) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 79129) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-07-13 |
| Last Update Date | 2023-10-20 |