Provider Demographics
NPI:1104422138
Name:JACKSON, KIMBERLY S (RN)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:S
Last Name:JACKSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:S
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:201 BEACON PKWY W STE 117
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-3147
Mailing Address - Country:US
Mailing Address - Phone:205-202-5297
Mailing Address - Fax:205-202-6250
Practice Address - Street 1:201 BEACON PKWY W STE 117
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-3147
Practice Address - Country:US
Practice Address - Phone:205-202-5297
Practice Address - Fax:205-202-6250
Is Sole Proprietor?:No
Enumeration Date:2020-12-06
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-153976163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health