Individual
JERMAL JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RRT
Contact information
Practice address
CORNER OF ROUTES N12 & N7, FORT DEFIANCE, AZ 86504
(928) 729-8000
Mailing address
8226 MENAUL BLVD NE # 556, ALBUQUERQUE, NM 87110-4614
Taxonomy
Speciality
Code
Description
License number
State
2279C0205X
Critical Care Registered Respiratory Therapist
Primary
—
NM
2279P3900X
Neonatal/Pediatric Registered Respiratory Therapist
—
NM
Other
Enumeration date
07/06/2022
Last updated
07/06/2022
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