| NPI | 1851709877 |
|---|---|
| Former Name | BETHANY ANNE JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: DE C5-0000953) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: DC PA031316) |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2020-05-08 |