Healthcare Provider Details

I. General information

NPI: 1457330227
Provider Name (Legal Business Name): KRISTA L. JACKSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTA L. WELCH PA-C

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 WEST ST
PAINTSVILLE KY
41240-1054
US

IV. Provider business mailing address

313 WEST ST
PAINTSVILLE KY
41240-1054
US

V. Phone/Fax

Practice location:
  • Phone: 606-788-6415
  • Fax: 606-372-6001
Mailing address:
  • Phone: 606-788-6415
  • Fax: 606-372-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 586
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: