| Doctor Name: | KIMBERLY MICHELLE JACKSON |
| NPI Number: | 1245670116 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP-C |
| License Number: | F0613462 |
| Business Practice Address: | 710 N Main St Springboro, OH - 450668944 |
| Business Phone Number: | 9377481135 |
| Business Fax Number: | |
| Mailing Address: | 4387 Leeds Point Ct, Apt 279 WEST CHESTER |
| State: | OH |
| Postal Code: | 450698769 |
| Phone Number: | 6785204851 |
| Fax Number: | |
| NPI Enumeration Date: | 06/25/2013 |
| NPI Last Update Date: | 05/09/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | F0613462 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |