Jackson, Jennifer C.

Jackson, Jennifer C. is an individual health care provider with primary practice located at 200 Clinic Dr , Madisonville KY 42431-1661. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Occupational Medicine. Allopathic & Osteopathic Physicians / Family Medicine is her primary health care specialty. Jackson, Jennifer C. can be contacted via phone (270) 825-7200.

Contact Information

Primary practice address
200 Clinic Dr Madisonville KY 42431-1661
Phone: (270) 825-7200
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 23527 Kentucky
Allopathic & Osteopathic Physicians / Occupational Medicine 2083X0100X 23527 Kentucky

Profile Details

NPI number 1417054040
LBN Legal business name Jackson, Jennifer C.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 17th, 2006
Last updated Oct 8th, 2010 - about 15 years ago

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 1417054040 NPPES
Kentucky Other 23527 LICENSE
Kentucky Other 000000044291 LICENSE
Kentucky MEDICAID 64235278 LICENSE

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