Individual
STACIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1630 DRY CREEK DR STE 200, LONGMONT, CO 80503-6405
(720) 279-9098
(720) 540-4250
Mailing address
6500 WEST 29TH ST STE 106, GREELEY, CO 80634-8386
(970) 330-5555
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.0005029
CO
Other
Enumeration date
07/27/2017
Last updated
08/03/2021
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