Provider Demographics
NPI:1407163231
Name:JACKSON, DARLA JILL
Entity Type:Individual
Prefix:MRS
First Name:DARLA
Middle Name:JILL
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DARLA
Other - Middle Name:JILL
Other - Last Name:HORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:418 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:KY
Mailing Address - Zip Code:42041-1230
Mailing Address - Country:US
Mailing Address - Phone:812-204-0547
Mailing Address - Fax:
Practice Address - Street 1:418 PEARL ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:KY
Practice Address - Zip Code:42041-1230
Practice Address - Country:US
Practice Address - Phone:812-204-0547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist