Individual
MR. JAMES AVEY JELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1001 NOBLE ST, FAIRBANKS, AK 99701-4922
(907) 458-2682
(907) 458-2628
Mailing address
1001 NOBLE ST, FAIRBANKS, AK 99701-4922
(907) 459-3500
(907) 458-2628
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
750
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MDA0096
—
AK
Enumeration date
04/19/2007
Last updated
03/07/2023
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