Jackson, Nicole Kimberly
Jackson, Nicole Kimberly is an individual health care provider with primary practice located at 525 Lilly Rd Ne Ste 200 , Olympia WA 98506. She recently has only one registered license in Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery), which is considered as her primary health care specialty. Jackson, Nicole Kimberly can be contacted via phone (360) 493-4510.Contact Information
Primary practice address
525 Lilly Rd Ne Ste 200
Olympia WA 98506
Phone: (360) 493-4510
Fax: (360) 493-7759
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | OP60418108 | Washington |
Profile Details
| NPI number | 1508188343 |
|---|---|
| LBN Legal business name | Jackson, Nicole Kimberly |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 21st, 2010 |
| Last updated | Jun 12th, 2018 - about 6 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1508188343 | NPPES |
| Washington | MEDICAID | OL60099734 |
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