Healthcare Provider Details

I. General information

NPI: 1760341960
Provider Name (Legal Business Name): JADE NICOLE JACKSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 PTARMIGAN LN
HELENA MT
59602-0521
US

IV. Provider business mailing address

3330 PTARMIGAN LN
HELENA MT
59602-0521
US

V. Phone/Fax

Practice location:
  • Phone: 406-457-4180
  • Fax:
Mailing address:
  • Phone: 406-457-4180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number174587
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: