Provider Demographics
NPI:1619600681
Name:ARTHUR JACKSON, JUDY NANESI (PA)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:NANESI
Last Name:ARTHUR JACKSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:588 LONGMEADOW ST
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-2212
Mailing Address - Country:US
Mailing Address - Phone:413-565-1000
Mailing Address - Fax:
Practice Address - Street 1:305 BICENTENNIAL HIGHWAY
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118
Practice Address - Country:US
Practice Address - Phone:413-733-4101
Practice Address - Fax:413-783-9544
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2024-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA9504363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant