Individual
MRS. HEIDI JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
1700 CLINTON ST, MUSKEGON, MI 49442-5502
(231) 728-5692
(231) 728-4017
Mailing address
PO BOX 1847, MUSKEGON, MI 49443-1847
(231) 727-4444
(231) 727-4451
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601004005
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MI1763007
MEDICARE
MI
Enumeration date
07/10/2006
Last updated
10/08/2015
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