Individual
KRISTINA E JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1501 NE MEDICAL CENTER DR, BEND, OR 97701-6051
(541) 382-2811
Mailing address
1501 NE MEDICAL CENTER DR, BEND, OR 97701-6051
(541) 382-2811
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
104267
MT
207Q00000X
Family Medicine Physician
9176939-1204
UT
207Q00000X
Family Medicine Physician
Primary
DO176817
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DO176817
OR LICENSE
OR
Enumeration date
05/16/2013
Last updated
02/11/2025
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