MEDICARE: ASHLEY JACKSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula		NY

General Provider Information

NPI Number	:	1114855285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY JACKSON

Provider Business Mailing Address
First Line	:	1786 KENMORE AVE APT B
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14216-1058
Country	:	US
Telephone Number	:	716-388-7598
Fax Number	:

Provider Business Practice Location Address
First Line	:	1786 KENMORE AVE APT B
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14216-1058
Country	:	US
Telephone Number	:	716-388-7598
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2026
Last Update Date	:	05/11/2026

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Directions to “ ASHLEY JACKSON ” Practice Location

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