Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DERRELL GLENN JACKSON, PA-C
ActiveDERRELL GLENN JACKSON, PA-C is a Physician Assistant healthcare provider located in COLONIAL HEIGHTS, Virginia. NPI 1104072297 is currently active in the NPPES registry. Verify at CMS.
Physician Assistant · COLONIAL HEIGHTS, VA
Registration Details
- NPI Number
- 1104072297
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Aug 8, 2008 (17.98420429786 yrs)
- Last Updated
- May 26, 2010
- Licenses
-
0110002804 (VA)0110002804 (VA)
Practice Information
- Address
-
436 CLAREMONT CTSUITE 100COLONIAL HEIGHTS, VA, 238341765Browse VA providers · Browse ZIP 23834
- Phone
- 8045262121
- Fax
- 8045202617
- Primary Specialty
-
Physician Assistant
363A00000X
- Additional Specialty
- Physician Assistant
Other Physician Assistant Providers in COLONIAL HEIGHTS, VA
| Name | Credential | NPI |
|---|---|---|
| JOHN P IMPASTATO | PA-C | 1053319590 |
| KRIS D CLARK | PA | 1154318624 |
| MR. RICHARD ACEVEDO | PHYSICIAN ASSISTANT | 1861409187 |
| NATALE S FATCHET | PA-C | 1346424900 |
| CAROL LUND | PA | 1235379363 |
| BRADLEY E KOLESAR | PA-C | 1356676225 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.