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General NPI Number Information
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NPI Number | 1932947488
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Entity Type | Individual
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Provider Name | KHALED JACKSON RN
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Gender | Male
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Dates
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Enumeration Date | 07/18/2024
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Last Update Date | 07/18/2024
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Provider Practice Location Address
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Address Line | 650 HOWE AVE # 400-A
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City | SACRAMENTO
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State | CA
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Zip | 95825-4731
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Country | US
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Telephone | 916-441-0123
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 348563
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City | SACRAMENTO
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State | CA
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Zip | 95834-8563
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Country | US
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Telephone | 708-516-0727
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95859029
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License Number State | CA
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