Jackson, Russell Patrick

Jackson, Russell Patrick is an sole proprietor health care provider with primary practice located at 301 E Cottonwood Ln Ste 1&2 , Casa Grande AZ 85122-2551. He recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Physician Assistants & Advanced Practice Nursing Providers / Medical. Physician Assistants & Advanced Practice Nursing Providers / Medical is his primary health care specialty. Jackson, Russell Patrick can be contacted via phone (602) 569-3999.

Contact Information

Primary practice address
301 E Cottonwood Ln Ste 1&2 Casa Grande AZ 85122-2551
Phone: (602) 569-3999
Fax: (520) 340-4359
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 8654 Arizona

Profile Details

NPI number 1699322578
LBN Legal business name Jackson, Russell Patrick
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 24th, 2019
Last updated May 4th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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