Travis Wiley Jackson, MD

Dermatology Physician · Saint Louis, MO

Individual Active NPI

NPI number 1093657439

Practice location

621 S New Ballas Rd Ste 3019b
Saint Louis, MO 63141-8267
Phone
(314) 509-5305
Fax
(314) 251-4454

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NPI record

NPI
1093657439
Entity type
Individual (Type 1)
Enumeration date
April 6, 2026
Last updated
May 27, 2026
Certified
May 27, 2026
Sole proprietor
Yes

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Dermatology Physician Primary 207N00000X 2026021643 MO

About Dr. Jackson

Travis Wiley Jackson, MD is a healthcare provider registered in the NPI registry with the primary taxonomy Dermatology Physician (code 207N00000X). The practice location is 621 S New Ballas Rd Ste 3019b, Saint Louis, MO 63141-8267. The NPI number 1093657439 was assigned on April 6, 2026 and the record was last updated on May 27, 2026.

Dr. Jackson lists a license in the registry: #2026021643 (MO) for Dermatology Physician. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Travis Wiley Jackson, MD?

The NPI number is 1093657439.

What is the phone number of Dr. Jackson?

The phone number listed for the practice location is (314) 509-5305.

Where is Dr. Jackson located?

621 S New Ballas Rd Ste 3019b, Saint Louis, MO 63141-8267.

What is the taxonomy code for Dr. Jackson?

The primary taxonomy code is 207N00000X – Dermatology Physician.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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