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BENNETT J JACKSON ANP
>> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1568523157
Individual Registrant: BENNETT J JACKSON ANP
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
6307 DEBARR RD STE C ANCHORAGE, AK 99504-1783 US
Tel: 907-333-7425 Fax: 907-333-7719
Tel: 907-333-7425 Fax: 907-333-7719
Contact information for business:
6307 DEBARR RD STE C ANCHORAGE, AK 99504-1783 US
Tel: 907-333-7425 Fax: 907-333-7719
Tel: 907-333-7425 Fax: 907-333-7719
Registration Information:
NPI: 1568523157
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner | AK | 666 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| GROUP NPI | 1730113739 | AK | 01 |
| NP39831 | AK | 05 |
