Individual
MR. DONALD L JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA C
Contact information
Practice address
840 S MEYERS ST, KETTLE FALLS, WA 99141
(509) 738-6607
(509) 738-4180
Mailing address
PO BOX 421, LIBERTY LAKE, WA 99019-0421
(866) 747-2455
(509) 944-9644
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10001811
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
127584
L & I
—
05
—
8118986
—
WA
01
—
8935341
L & I CRIME VICTIMS
—
Enumeration date
10/12/2005
Last updated
10/28/2014
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