Individual
DARRELL JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
357 W TROY ST, KUNA, ID 83634-5002
(309) 648-5154
Mailing address
357 W TROY ST, KUNA, ID 83634-5002
(309) 648-5154
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
01/17/2020
Last updated
01/17/2020
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