Individual
JENNIFER ELLEN JACKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
825 EASTLAKE AVE E, SEATTLE, WA 98109
(206) 606-6692
(206) 606-1435
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
(206) 520-5700
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
AP30007362
WA
363LF0000X
Family Nurse Practitioner
Primary
AP30007362
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0274647
L&I
WA
05
—
1275606774
—
WA
Enumeration date
11/15/2006
Last updated
09/05/2018
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