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Organization
THE JACKSON MACY CLINIC LLC
Active
Organization
THE JACKSON MACY CLINIC LLC
Active
Other names
The Jackson Macy Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY GRANT WHCNP-BC, CNM (OWNER)
(503) 724-8188
Entity
Organization
Contact information
Practice address
19365 SW 65TH AVE STE 105, TUALATIN, OR 97062-9196
(503) 454-0018
(503) 848-3471
Mailing address
19365 SW 65TH AVE STE 105, TUALATIN, OR 97062-9196
(503) 454-0018
(503) 848-3471
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
—
NULL
363LW0102X
Women's Health Nurse Practitioner
—
—
367A00000X
Advanced Practice Midwife
Primary
—
NULL
367A00000X
Advanced Practice Midwife
Primary
—
—
Other
Enumeration date
01/23/2023
Last updated
11/21/2023
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