Derrell Glenn Jackson, PA-C

Physician Assistant · Colonial Heights, VA

Individual Active NPI

NPI number 1104072297

Practice location

436 Claremont Ct
Suite 100
Colonial Heights, VA 23834-1765
Phone
(804) 526-2121
Fax
(804) 520-2617

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NPI record

NPI
1104072297
Entity type
Individual (Type 1)
Enumeration date
August 8, 2008
Last updated
May 26, 2010
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Physician Assistant Primary 363A00000X 0110002804 VA
Medical Physician Assistant 363AM0700X 0110002804 VA

Mailing address

205 Misty Ridge Ln
Suffolk, VA 23434-1516
Phone
(757) 406-7328

About Derrell Jackson

Derrell Glenn Jackson, PA-C is a healthcare provider registered in the NPI registry with the primary taxonomy Physician Assistant (code 363A00000X). The practice location is 436 Claremont Ct, Suite 100, Colonial Heights, VA 23834-1765. The NPI number 1104072297 was assigned on August 8, 2008 and the record was last updated on May 26, 2010.

Derrell Jackson lists 2 licenses in the registry: #0110002804 (VA) for Physician Assistant; #0110002804 (VA) for Medical Physician Assistant. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Derrell Glenn Jackson, PA-C?

The NPI number is 1104072297.

What is the phone number of Derrell Jackson?

The phone number listed for the practice location is (804) 526-2121.

Where is Derrell Jackson located?

436 Claremont Ct, Suite 100, Colonial Heights, VA 23834-1765.

What is the taxonomy code for Derrell Jackson?

The primary taxonomy code is 363A00000X – Physician Assistant; 1 more listed above.

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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