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General NPI Number Information
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NPI Number | 1770199325
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Entity Type | Individual
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Provider Name | EMMA ANNE JACKSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/18/2020
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Last Update Date | 06/09/2021
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Provider Practice Location Address
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Address Line | 801 N 29TH ST
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City | BILLINGS
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State | MT
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Zip | 59101-0905
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Country | US
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Telephone | 406-238-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 2243 DARCY LN
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City | BILLINGS
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State | MT
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Zip | 59102-2035
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Country | US
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Telephone | 425-233-2803
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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