Jackson, Mary Anne

Jackson, Mary Anne is an individual health care provider with primary practice located at 2401 Gillham Rd , Kansas City MO 64108-4619. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatric Infectious Diseases, which is considered as her primary health care specialty. Jackson, Mary Anne can be contacted via phone (816) 234-3061.

Contact Information

Primary practice address
2401 Gillham Rd Kansas City MO 64108-4619
Phone: (816) 234-3061
Fax: (816) 346-1328
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatric Infectious Diseases 2080P0208X R8D24 Missouri

Profile Details

NPI number 1710938188
LBN Legal business name Jackson, Mary Anne
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 12th, 2006
Last updated Jun 22nd, 2011 - about 13 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 1710938188 NPPES
Missouri MEDICAID 202250304
Missouri MEDICAID 100204990A

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