Basic Information
| Provider Information | |||||||||
| NPI: | 1598148819 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JACKSON | ||||||||
| FirstName: | LINDSEY | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2195 HARRODSBURG RD STE 125 | ||||||||
| Address2: | SUITE 125 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405043504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592574732 | ||||||||
| FaxNumber: | 8593236661 | ||||||||
| Practice Location | |||||||||
| Address1: | 2195 HARRODSBURG RD STE 125 | ||||||||
| Address2: | SUITE 125 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592574732 | ||||||||
| FaxNumber: | 8593236661 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2015 | ||||||||
| LastUpdateDate: | 06/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R3806 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | TP478 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.