MEDICARE: DR. AMI JACKSON DO

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207ZF0201X	Forensic Pathology Physician	OP61585845	WA

General Provider Information

NPI Number	:	1326570383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMI JACKSON DO

Provider Business Mailing Address
First Line	:	3619 PACIFIC AVE
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98418-7921
Country	:	US
Telephone Number	:	537-986-4942
Fax Number	:

Provider Business Practice Location Address
First Line	:	3619 PACIFIC AVE
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98418-7921
Country	:	US
Telephone Number	:	253-798-6494
Fax Number	:

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

Provider Enumeration Date	:	03/29/2017
Last Update Date	:	04/04/2025

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