Provider Demographics
NPI:1689167736
Name:JACKSON, BILLIE JO (APRN)
Entity Type:Individual
Prefix:MRS
First Name:BILLIE
Middle Name:JO
Last Name:JACKSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:KY
Mailing Address - Zip Code:40806-8321
Mailing Address - Country:US
Mailing Address - Phone:606-574-0939
Mailing Address - Fax:
Practice Address - Street 1:18880 N US HIGHWAY 119
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:KY
Practice Address - Zip Code:40823-8106
Practice Address - Country:US
Practice Address - Phone:606-589-0130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012226363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3012226OtherKENTUCKY BOARD OF NURSING