RUSSELL PATRICK JACKSON NPI 1699322578

NPI Information

NPI: 1699322578
Provider Name: RUSSELL PATRICK JACKSON
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

PECOS Registration: Yes

Address:
301 E COTTONWOOD LN STE 1&2
CASA GRANDE, AZ
ZIP 85122
Phone: (602) 569-3999
Get Directions

Russell Patrick Jackson is a medical physician assistant in Casa Grande, AZ with 3 years of experience. Russell Patrick Jackson NPI is 1699322578. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

301 E COTTONWOOD LN STE 1&2
CASA GRANDE, AZ
ZIP 85122-551
Phone: (602) 569-3999
Fax: (520) 340-4359

The NPI 1699322578 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/24/2019 and was last updated on 5/4/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	390200000X	Student in an Organized Health Care Education/Training Program				No
2	363AM0700X	Physician Assistant	Medical	8654	ARIZONA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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