Individual
RANDY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
280 PATTONSVILLE RD, JACKSON, OH 45640-9452
(740) 446-5000
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5387
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN.CRNA.0020099
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0408956
—
OH
Enumeration date
06/02/2020
Last updated
01/21/2021
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