Healthcare Provider Details

I. General information

NPI: 1629905609
Provider Name (Legal Business Name): VICTORIA JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 RAILWAY AVE
SEWARD AK
99664-0999
US

IV. Provider business mailing address

PO BOX 1045
SEWARD AK
99664-1045
US

V. Phone/Fax

Practice location:
  • Phone: 360-528-0956
  • Fax: 360-528-0956
Mailing address:
  • Phone: 907-224-5257
  • Fax: 907-224-5257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number206097
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: