Provider Demographics
NPI:1760197040
Name:JACKSON, KINSEY L (COMS)
Entity Type:Individual
Prefix:
First Name:KINSEY
Middle Name:L
Last Name:JACKSON
Suffix:
Gender:M
Credentials:COMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2657 ATWOOD TER
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43211-1103
Mailing Address - Country:US
Mailing Address - Phone:614-208-7506
Mailing Address - Fax:
Practice Address - Street 1:2657 ATWOOD TER
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43211-1103
Practice Address - Country:US
Practice Address - Phone:614-208-7506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, BlindGroup - Single Specialty