Individual
AMANDA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
300 N PARK AVE, ELLINWOOD, KS 67526-1452
(620) 566-1730
(620) 564-2105
Mailing address
300 N PARK AVE, ELLINWOOD, KS 67526-1452
(620) 566-1730
(620) 564-2105
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
Primary
13-132083-062
KS
Other
Enumeration date
11/04/2024
Last updated
11/04/2024
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