Individual
CORY LYNN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 NOME BYPASS ROAD, NOME, AK 99762-0966
(907) 443-9603
Mailing address
PO BOX 966, NOME, AK 99762-0966
(907) 443-9603
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000
—
AK
Enumeration date
04/09/2018
Last updated
04/09/2018
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