Provider Demographics
NPI:1083325955
Name:LOVEWELL, JACKSON THOMAS (NP)
Entity Type:Individual
Prefix:
First Name:JACKSON
Middle Name:THOMAS
Last Name:LOVEWELL
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77R W MAIN ST # R
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-1688
Mailing Address - Country:US
Mailing Address - Phone:508-435-5506
Mailing Address - Fax:
Practice Address - Street 1:77R W MAIN ST # R
Practice Address - Street 2:
Practice Address - City:HOPKINTON
Practice Address - State:MA
Practice Address - Zip Code:01748-1688
Practice Address - Country:US
Practice Address - Phone:508-435-5506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2325815363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics