Individual
BLAKE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
300 CARSON ST, JONESBORO, AR 72401-3104
(709) 321-1988
(870) 910-7700
Mailing address
4 WILLOW CREEK LN APT 4302, JONESBORO, AR 72404-7991
(954) 464-8137
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/10/2023
Last updated
04/10/2023
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