Individual
CARYN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
12 S 8TH ST, YAKIMA, WA 98901-3020
(509) 454-4143
(509) 454-4115
Mailing address
PO BOX 2605, YAKIMA, WA 98907-2605
(509) 454-4143
(509) 454-4115
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00045020
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0201199
L & I
WA
05
—
8435794
—
WA
01
—
911019392
COMMERCIAL
—
01
—
9370CO
REGENCE
WA
Enumeration date
10/03/2006
Last updated
08/27/2012
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