Individual
JIMMY R JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R539929
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00110004
—
MS
05
—
009936743
—
AL
Enumeration date
07/17/2006
Last updated
11/09/2010
Update your record
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