Individual
JACY LYN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
117 N UNION ST STE 1, PONCA, NE 68770-7297
(712) 251-7523
Mailing address
PO BOX 645, PONCA, NE 68770-0645
(712) 251-7523
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
—
—
Other
Enumeration date
05/14/2026
Last updated
05/14/2026
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