Individual
BENNETT J JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ANP
Contact information
Practice address
6307 DEBARR RD STE C, ANCHORAGE, AK 99504-1783
(907) 333-7425
(907) 333-7719
Mailing address
PO BOX 110413, ANCHORAGE, AK 99511-0413
(907) 333-7425
(907) 333-7719
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
666
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1730113739
GROUP NPI
AK
01
—
743109721
GROUP TAX ID
AK
05
—
NP39831
—
AK
Enumeration date
12/13/2006
Last updated
11/01/2024
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