Basic Information
| Provider Information | |||||||||
| NPI: | 1871012682 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JACKSON | ||||||||
| FirstName: | KIMBERLY | ||||||||
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| Credential: | DNP, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3258 SPRINGFIELD DR | ||||||||
| Address2: | |||||||||
| City: | LINCOLNTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280929336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043205347 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2359 SPRINGS RD NE | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286013067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282569853 | ||||||||
| FaxNumber: | 8282561255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2017 | ||||||||
| LastUpdateDate: | 09/12/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 5009861 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.