| Doctor Name: | DR. KIMBERLEY EVELYN JACKSON |
| NPI Number: | 1154586832 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | D.O. |
| License Number: | OS014960 |
| Business Practice Address: | 902 Lakeview Ave Pueblo, CO - 810043597 |
| Business Phone Number: | 7195575855 |
| Business Fax Number: | 7195574690 |
| Mailing Address: | 902 Lakeview Ave, PUEBLO |
| State: | CO |
| Postal Code: | 810043597 |
| Phone Number: | 7195575855 |
| Fax Number: | 7195574690 |
| NPI Enumeration Date: | 07/22/2008 |
| NPI Last Update Date: | 09/16/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | OS014960 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |