Most Relevant Information
Provider Data
| NPI Number: | 1003057621 |
| Provider Name: | KIERNEY ELIZABETH JACKSON PA |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | 1397 |
Most Important Dates
| Enumeration Date: | 03/11/2009 |
| Last Updated: | 12/16/2016 |
Provider Practice Location
1350 S KINGS DR
CHARLOTTE
NC
282072134
Practice Location Phone/Fax
| Phone: | 7044461255 |
| Fax: | 7044461276 |
Provider Mailing Location
PO BOX 601372
CHARLOTTE
NC
282601372
Provider Mailing Phone/Fax
| Phone: | 7044461255 |
| Fax: | 7044461276 |