Provider Demographics
NPI:1942679568
Name:JACKSON, JAMIE E (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:JAMIE
Middle Name:E
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 COMAL ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-4597
Mailing Address - Country:US
Mailing Address - Phone:737-270-9500
Mailing Address - Fax:833-906-2436
Practice Address - Street 1:310 COMAL ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-4597
Practice Address - Country:US
Practice Address - Phone:737-270-9500
Practice Address - Fax:833-906-2436
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA057857363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant