Individual
COREY JERROD JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
601 ELMWOOD AVE, ROCHESTER, NY 14642-0001
(585) 275-4912
(585) 276-2144
Mailing address
601 ELMWOOD AVE BOX HMD, ROCHESTER, NY 14642-0001
(585) 784-9842
(585) 427-8718
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
702343
NY
363LF0000X
Family Nurse Practitioner
Primary
342473
NY
Other
Enumeration date
07/10/2015
Last updated
06/29/2023
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