Organization
KELLY JACKSON
Active
Organization
KELLY JACKSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY JACKSON NP (OWNER)
(214) 227-2457
Entity
Organization
Contact information
Practice address
9345 E VOLTAIRE AVE, SCOTTSDALE, AZ 85260-7432
(214) 227-2457
(214) 764-0880
Mailing address
9345 E VOLTAIRE AVE, SCOTTSDALE, AZ 85260-7432
(214) 227-2457
(214) 764-0880
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
AP4200
AZ
Other
Enumeration date
03/10/2015
Last updated
03/10/2015
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