Individual
JOHN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
137 S NEWPORT AVE, NEWPORT, WA 99156-1942
(509) 447-1200
(509) 447-1201
Mailing address
PO BOX 1942, NEWPORT, WA 99156-1942
(509) 447-1200
(509) 447-1201
Taxonomy
Speciality
Code
Description
License number
State
146L00000X
Paramedic
Primary
PARA.ED.00104712
WA
Other
Enumeration date
03/06/2017
Last updated
03/06/2017
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