Provider Demographics
NPI:1457426942
Name:JACKSON, AMY L (PA)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:L
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:2817 ROCK MERRITT AVENUE
Mailing Address - Street 2:
Mailing Address - City:FORT LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:28310-0001
Mailing Address - Country:US
Mailing Address - Phone:910-907-6000
Mailing Address - Fax:
Practice Address - Street 1:1650 COCHRANE CIR BLDG 7505
Practice Address - Street 2:EVANS ARMY COMMUNITY HOSPITAL
Practice Address - City:FT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4604
Practice Address - Country:US
Practice Address - Phone:719-526-7000
Practice Address - Fax:719-526-7732
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2023-11-09
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN