Most Relevant Information
Provider Data
| NPI Number: | 1003470311 |
| Provider Name: | NICOLA NATASHA JACKSON MD |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/23/2019 |
| Last Updated: | 07/01/2024 |
Provider Practice Location
651 CENTRE VIEW BLVD
CRESTVIEW HILLS
KY
410175419
Practice Location Phone/Fax
| Phone: | 8593441900 |
| Fax: | 8593444632 |
Provider Mailing Location
PO BOX 635283
CINCINNATI
OH
452635283
Provider Mailing Phone/Fax
| Phone: | 8593441900 |
| Fax: | 8593444632 |