Search › Virginia › 363A00000X
Derrell Jackson, PA-C
NPI 1104072297 · on the registry since 2008
Practice
- Address
- 436 Claremont Ct
Suite 100
Colonial Heights, VA 23834 - Phone
- (804) 526-2121
- Fax
- (804) 520-2617
- Organisation at this address
- Petersburg Clinic Company, Llc
Petersburg Hospital Company LlcInferred from a shared address, not stated in the registry. - Clinicians at this address
- 3
Registry record
- Primary taxonomy
- 363A00000X
363A00000X
- Also registered as
- 363AM0700X
- Licence states on file
- VA
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2010-05-26
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Virginia