Provider Demographics
NPI:1932656584
Name:JACKSON, LINDSAY B (PA-C)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:B
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:B
Other - Last Name:STARKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2580 HAYMAKER RD STE 106
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3500
Mailing Address - Country:US
Mailing Address - Phone:412-858-7766
Mailing Address - Fax:412-858-7769
Practice Address - Street 1:2580 HAYMAKER RD STE 106
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3500
Practice Address - Country:US
Practice Address - Phone:412-858-7766
Practice Address - Fax:412-858-7769
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATMA053096363A00000X
PAMA058467363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
13906595OtherCAQH
PA103206164Medicaid