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BENNETT J JACKSON ANP

>> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1568523157

Individual Registrant:
 BENNETT J JACKSON ANP
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

Contact information for business:
6307 DEBARR RD STE C  ANCHORAGE, AK 99504-1783 US
Tel: 907-333-7425  Fax: 907-333-7719

Registration Information:
NPI: 1568523157
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363L00000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
AK666

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
GROUP NPI1730113739AK01
NP39831AK05




HEALTH CARE JOBS AK - Page 1



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