DR. KIMBERLEY EVELYN JACKSON D.O. NPI 1154586832

NPI Information

NPI: 1154586832
Provider Name: DR. KIMBERLEY EVELYN JACKSON, D.O.
Classification: General Practice - 208D00000X
Entity Type: Individual
Address:
902 LAKEVIEW AVE
PUEBLO, CO
ZIP 81004
Phone: (719) 557-5855
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DR. Kimberley Evelyn Jackson, D.O. is a general practice in Pueblo, CO. DR. Kimberley Evelyn Jackson, D.O. NPI is 1154586832. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

902 LAKEVIEW AVE
PUEBLO, CO
ZIP 81004-597
Phone: (719) 557-5855
Fax: (719) 557-4690

The enumeration date for this NPI number is 7/22/2008 and was last updated on 9/16/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208D00000X	General Practice		OS014960	PENNSYLVANIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	OS014960	OTHER	PENNSYLVANIA	PENNSYLVANIA OSTEOPATHIC MEDICAL BOARD
2	50533	OTHER	COLORADO	COLORADO LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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