| NPI | 1841629904 |
|---|---|
| Former Name | JAMIE LYN JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: MO 2013001641) |
| Enumeration Date | 2013-11-08 |
| Last Update Date | 2022-03-10 |