Jackson, Kyle Jefferson

Jackson, Kyle Jefferson is an individual health care provider with primary practice located at 619 S Fleishel Ave Suite 327, Tyler TX 75701-2004. He recently has only one registered license in Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism, which is considered as his primary health care specialty. Jackson, Kyle Jefferson can be contacted via phone (903) 510-1173.

Contact Information

Primary practice address
619 S Fleishel Ave Suite 327 Tyler TX 75701-2004
Phone: (903) 510-1173
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism 207RE0101X Q6851 Texas

Profile Details

NPI number 1548569056
LBN Legal business name Jackson, Kyle Jefferson
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 23rd, 2011
Last updated Sep 20th, 2016 - about 9 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 1548569056 NPPES
Texas Other 8GA283 BCBS
Texas MEDICAID 360453001 BCBS
Texas Other 75-2616977-123 BCBS
Texas Other P01697215 BCBS

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