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Kennie Jackson
NPI 1629380316 · on the registry since 2010
Practice
- Address
- 315 Palmyra Dr
Indianapolis, IN 46239 - Phone
- (317) 909-0320
Registry record
- Primary taxonomy
- 172A00000X
172A00000X
- Also registered as
- 372600000X
376J00000X - Licence states on file
- IN
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2024-08-19
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Indiana