| Derrell Glenn Jackson, PA-C | |
|
436 Claremont Ct, Suite 100, Colonial Heights, VA 23834-1765 | |
| (804) 526-2121 | |
| (804) 520-2617 |
| Full Name | Derrell Glenn Jackson |
|---|---|
| Gender | Male |
| Speciality | Physician Assistant |
| Location | 436 Claremont Ct, Colonial Heights, Virginia |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104072297 | NPI | - | NPPES |
| 1104072297 | Medicaid | VA | |
| 10040880P | Other | VA | OPTIMA |
| P00685057 | Other | VA | RR MEDICARE |
| 10040880P | Other | VA | SENTARA HEALTHCARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363AM0700X | Physician Assistant - Medical | 0110002804 (Virginia) | Secondary |
| 363A00000X | Physician Assistant | 0110002804 (Virginia) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Derrell Glenn Jackson, PA-C 205 Misty Ridge Ln, Suffolk, VA 23434-1516 Ph: (757) 406-7328 | Derrell Glenn Jackson, PA-C 436 Claremont Ct, Suite 100, Colonial Heights, VA 23834-1765 Ph: (804) 526-2121 |
John P Impastato, PA-C Physician Assistant Medicare: Medicare Enrolled Practice Location: 325 Charles H Dimmock Pkwy Ste 100, Colonial Heights, VA 23834 Phone: 804-526-5888 Fax: 804-526-5401 | |
Katherine Pearson Ruiz, PA-C Physician Assistant Medicare: Medicare Enrolled Practice Location: 110 Dunlop Circle Dr, Colonial Heights, VA 23834 Phone: 804-526-6062 Fax: 804-526-9094 | |
Heidi J Blair, PA Physician Assistant Medicare: Medicare Enrolled Practice Location: 211 Temple Ave, Colonial Heights, VA 23834 Phone: 804-526-0107 Fax: 804-526-4466 | |
Kris D Clark, PA Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 1260 Temple Ave, Colonial Heights, VA 23834 Phone: 804-518-2597 Fax: 804-518-2598 | |
Aubrey Munoz, Physician Assistant Medicare: Medicare Enrolled Practice Location: 280 Charles H Dimmock Pkwy Ste 2, Colonial Heights, VA 23834 Phone: 540-229-3159 | |
Carol Lund, PA Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2552 Aldridge Ave, Colonial Heights, VA 23834 Phone: 804-526-7990 |