Individual
TRAVIS JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10828 OLD MILL RD, OMAHA, NE 68154-2647
(402) 504-3219
Mailing address
10828 OLD MILL RD, OMAHA, NE 68154-2647
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
10/20/2025
Last updated
10/20/2025
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