Individual
BETHANY ROSE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2823 FRESNO ST, FRESNO, CA 93721-1324
(559) 443-2682
(559) 443-2681
Mailing address
2625 E DIVISADERO ST, FRESNO, CA 93721-1431
(559) 443-2682
(559) 443-2681
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
20A21130
CA
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
Primary
20A21130
CA
Other
Enumeration date
03/20/2017
Last updated
12/04/2023
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