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General NPI Number Information
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NPI Number | 1932978806
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Entity Type | Individual
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Provider Name | ROBIN L JACKSON
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Gender | Female
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Dates
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Enumeration Date | 12/20/2023
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Last Update Date | 12/20/2023
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Provider Practice Location Address
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Address Line | 43 E MAIN ST
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City | CLARKSVILLE
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State | OH
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Zip | 45113-7524
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Country | US
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Telephone | 937-302-9771
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 308
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City | CLARKSVILLE
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State | OH
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Zip | 45113-0308
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Country | US
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Telephone | 937-302-9771
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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