Healthcare Provider Details

I. General information

NPI: 1447462668
Provider Name (Legal Business Name): APRIL L JACKSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 OLD SYMSONIA RD
BENTON KY
42025-5094
US

IV. Provider business mailing address

619 OLD SYMSONIA RD
BENTON KY
42025-5094
US

V. Phone/Fax

Practice location:
  • Phone: 270-527-2411
  • Fax: 270-527-8734
Mailing address:
  • Phone: 270-527-2411
  • Fax: 270-527-8734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberTP249
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: