Jackson, Debra Kay

Jackson, Debra Kay is an individual health care provider with primary practice located at 4775 E Maryland St , Decatur IL 62521-8820. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Jackson, Debra Kay can be contacted via phone (217) 864-3737.

Contact Information

Primary practice address
4775 E Maryland St Decatur IL 62521-8820
Phone: (217) 864-3737
Fax: (217) 864-3468
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036092587 Illinois

Profile Details

NPI number 1942253489
LBN Legal business name Jackson, Debra Kay
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 18th, 2006
Last updated Jul 19th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1942253489 NPPES
Illinois Other 036.092587 MD LICESE

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