Organization
THE JACKSON MACY CLINIC LLC
Active
Other names
The Jackson Macy Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY GRANT WHCNP-BC, CNM (OWNER)
(503) 724-8188
Entity
Organization
Contact information
Practice address
19365 SW 65TH AVE STE 105, TUALATIN, OR 97062-9196
(503) 454-0018
(503) 848-3471
Mailing address
19365 SW 65TH AVE STE 105, TUALATIN, OR 97062-9196
(503) 454-0018
(503) 848-3471
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
—
—
367A00000X
Advanced Practice Midwife
Primary
—
—
Other
Enumeration date
01/23/2023
Last updated
11/21/2023
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