Brian Jackson
Technician, Other in Kennett, MO. Individual provider (NPI-1).
NPI number1659612364
StatusActive
Last updated in NPPESMar 5, 2013
Details
- NPI
- 1659612364
- Entity type
- Individual (NPI-1)
- Name
- Brian Jackson
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 5, 2013
- Last updated
- Mar 5, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 247200000X | Technician, Other | – | – | Yes |
Practice location
1109 Jones StKennett, MO 63857-3824
Phone 573-888-6545 · Fax 573-888-2369
Mailing address
1109 Jones StPo Box 470
Kennett, MO 63857-3824
Phone 573-888-6545 · Fax 573-888-2369
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