Individual
MS. JACQUELYN KAY RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
101 AIRPORT WAY, ILIAMNA, AK 99606
(907) 571-1818
Mailing address
31 EMBRETSON ROAD, ILIAMNA, AK 99606
(907) 744-8581
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
023071
NY
363A00000X
Physician Assistant
085.004670
IL
363A00000X
Physician Assistant
Primary
PADA481
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1639156268
NPI
—
05
—
1639156268
—
NY
Enumeration date
12/23/2005
Last updated
09/06/2024
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