Individual
TIMOTHY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
872 S CAMINO DEL PUEBLO, BERNALILLO, NM 87004-5927
(505) 867-2383
(505) 867-7293
Mailing address
700 AVANTI ST SW, ALBUQUERQUE, NM 87121-8665
(505) 565-1619
(505) 565-1620
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
NM
Other
Enumeration date
10/25/2006
Last updated
07/08/2007
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