Provider Information for 1770749905
The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.
Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know
Ms. ALFAYE JACKSON PLPC
Sex: Female
NPI: 1770749905
Last Updated: 2022-11-21
Certification Date: 2022-11-21
Certification Date: 2022-11-21
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1770749905 | ||||||||||||
| Enumeration Date | 2008-08-07 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 104 FOX CREEK RD ROLLA, MO 65401-3620 United States Phone: | Fax: | ||||||||||||
| Primary Practice Address | 104 FOX CREEK RD ROLLA, MO 65401-3620 United States Phone: 417-693-2770 | Fax: | ||||||||||||
| Secondary Practice Address(es) | |||||||||||||
| Health Information Exchange |
| ||||||||||||
| Other Identifiers |
| ||||||||||||
| Taxonomy |
|