| NPI | 1184185472 |
|---|---|
| Former Name | JAMIE ELAINE JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA 336913) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MS PA00423) |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2023-10-18 |