Individual
SHANETTE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
602 FRONTAGE ROAD, STE.206, KENAI, AK 99611
(907) 416-8276
Mailing address
10672 KENAI SPUR HWY STE 112, KENAI, AK 99611-7868
(907) 513-2467
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
128047
AK
Other
Enumeration date
03/30/2017
Last updated
04/15/2025
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