Derrell Glenn Jackson, PA-C
Physician Assistant in Colonial Heights, VA. Individual provider (NPI-1).
NPI number1104072297
StatusActive
Last updated in NPPESMay 26, 2010
Details
- NPI
- 1104072297
- Entity type
- Individual (NPI-1)
- Name
- Derrell Glenn Jackson
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 8, 2008
- Last updated
- May 26, 2010
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 0110002804 | VA | Yes |
| 363AM0700X | Physician Assistant, Medical | 0110002804 | VA |
Practice location
436 Claremont CtSuite 100
Colonial Heights, VA 23834-1765
Phone 804-526-2121 · Fax 804-520-2617
Mailing address
205 Misty Ridge LnSuffolk, VA 23434-1516
Phone 757-406-7328
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Other Physician Assistant providers in Colonial Heights, VA
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- Carolyn Mansour Herrera, PA-CNPI 1477834455
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- Kristin JoostemaNPI 1205526944
- Bradley E Kolesar, PA-CNPI 1356676225
All 15 Physician Assistant providers in Colonial Heights · All 715 providers in Colonial Heights
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