| Doctor Name: | MS. KIMBERLY A JACKSON |
| NPI Number: | 1083923353 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 336506 |
| Business Practice Address: | 31 Weber Hill Rd Mahopac, NY - 105411829 |
| Business Phone Number: | 9142608087 |
| Business Fax Number: | 8457675088 |
| Mailing Address: | 31 Weber Hill Rd, MAHOPAC |
| State: | NY |
| Postal Code: | 105411829 |
| Phone Number: | 9142608087 |
| Fax Number: | 8457675088 |
| NPI Enumeration Date: | 10/04/2010 |
| NPI Last Update Date: | 03/29/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 336506 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |