Individual
JACKIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
201 N K ST, TULARE, CA 93274-4005
(559) 521-9023
Mailing address
2100 S LASPINA ST APT 107, TULARE, CA 93274-6902
(559) 837-8505
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
07/03/2024
Last updated
07/03/2024
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