Individual
MR. KEITH ALLEN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3000 Q ST FL 4, SACRAMENTO, CA 95816-7058
(916) 733-5700
(916) 733-5714
Mailing address
3400 DATA DR, RANCHO CORDOVA, CA 95670-7956
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA55837
CA
Other
Enumeration date
08/13/2018
Last updated
10/09/2018
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