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NPI Code Detail

MEDICARE: DEBRA JACKSON

MEDICARE: DEBRA JACKSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1477569515
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBRA JACKSON
Provider Business Mailing Address
First Line : PO BOX 568
Second Line :
City : CORBIN
State : KY
Zip : 40702-0568
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1203 AMERICAN GREETING CARD RD
Second Line :
City : CORBIN
State : KY
Zip : 40701-4811
Country : US
Telephone Number : 606-528-7010
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2006
Last Update Date : 03/04/2025

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