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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1508188343 NPPES
Washington MEDICAID OL60099734

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