Jackson, Willie Mae

Jackson, Willie Mae is an individual health care provider with primary practice located at 2211 Mayfair Dr Suite 409, Owensboro KY 42301-4568. She recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Psychiatry. Allopathic & Osteopathic Physicians / Psychiatry is her primary health care specialty. Jackson, Willie Mae can be contacted via phone (270) 417-7980.

Contact Information

Primary practice address
2211 Mayfair Dr Suite 409 Owensboro KY 42301-4568
Phone: (270) 417-7980
Fax: (270) 417-7989
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 46400 Kentucky

Profile Details

NPI number 1073754065
LBN Legal business name Jackson, Willie Mae
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 20th, 2009
Last updated Nov 4th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1073754065 NPPES
Kentucky MEDICAID 7100137210

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