Provider Demographics
NPI:1740649011
Name:JACKSON, THOMAS ANDREW (CRNA)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ANDREW
Last Name:JACKSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2507 N MERCER ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1707
Mailing Address - Country:US
Mailing Address - Phone:724-944-1972
Mailing Address - Fax:
Practice Address - Street 1:1995 EAST STATE STREET
Practice Address - Street 2:SALEM REGIONAL MEDICAL CENTER
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460
Practice Address - Country:US
Practice Address - Phone:330-332-1551
Practice Address - Fax:330-332-7899
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2023-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.18640-NA367500000X
OHRN.396530-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse