Individual
JASON JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BS
Contact information
Practice address
10052 COORS BLVD NW, ALBUQUERQUE, NM 87114-4020
(505) 459-0025
(505) 899-8372
Mailing address
PO BOX 66255, ALBUQUERQUE, NM 87193-6255
(505) 459-0025
(505) 899-8372
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
11/15/2024
Last updated
11/15/2024
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