| Doctor Name: | KIMBERLY HATCH JACKSON |
| NPI Number: | 1215171798 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ARNP |
| License Number: | ARNP 9265719 |
| Business Practice Address: | 140 Sw Virginia Cir Mayo, FL - 320664064 |
| Business Phone Number: | 3862941321 |
| Business Fax Number: | 3862943876 |
| Mailing Address: | 140 Sw Virginia Cir, Po Box 1806 MAYO |
| State: | FL |
| Postal Code: | 320664064 |
| Phone Number: | 3862941321 |
| Fax Number: | 3862943876 |
| NPI Enumeration Date: | 04/28/2009 |
| NPI Last Update Date: | 04/28/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | ARNP 9265719 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |