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NPI Code Detail

MEDICARE: JEFFREY N JACKSON PSYCHOLOGIST

MEDICARE: JEFFREY N JACKSON PSYCHOLOGIST
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
1103T00000XPsychologist1279KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386669380
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY N JACKSON PSYCHOLOGIST
Provider Business Mailing Address
First Line : 101 W MUHAMMAD ALI BLVD
Second Line :
City : LOUISVILLE
State : KY
Zip : 40202-1423
Country : US
Telephone Number : 502-589-8600
Fax Number : 502-589-8771
Provider Business Practice Location Address
First Line : 914 E BROADWAY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40204-1037
Country : US
Telephone Number : 502-589-8600
Fax Number : 502-589-8771
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2006
Last Update Date : 03/05/2015

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