Individual
MR. JACKSON GREY LIKENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3651 ASHWORTH AVE N UNIT B, SEATTLE, WA 98103-8116
(407) 927-1656
Mailing address
18012 68TH AVE S STE 101, KENT, WA 98032-1022
(425) 291-3300
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
9116959
FL
363A00000X
Physician Assistant
Primary
PA61450103
WA
Other
Enumeration date
06/14/2023
Last updated
04/24/2024
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