MS. PHYLLIS E JACKSON (NPI# 1043649627) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043649627 |
| Entity Type | Individual |
| Full Name | MS. PHYLLIS E JACKSON |
| Credential | PA-C |
| Practice Address |
300 Evergreen Dr Suite 150 Glen Mills PA 19342-1059 |
| Practice Telephone | 6108741184 |
| Practice Fax Number | 6108744258 |
| Mailing Telephone | 6108741184 |
| Mailing Fax Number | 6108744258 |
| Enumeration Date | 2013-11-05 |
| Last Update Date | 2014-05-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | MA000510L | PA | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033665666 | Phyllis Jackson | Counselor | 411 Colonial Dr, Baton Rouge, LA 70806-6506 | 2016-09-01 |
| 1891133898 | Phyllis Jackson | Social Worker | 12647 Olive Blvd, Suite 600, Saint Louis, MO 63141-6393 | 2013-06-12 |
| 1780887018 | Phyllis Jackson | Registered Nurse | 1019 E Water St, Elmira, NY 14901-3332 | 2007-06-06 |
| 1154473684 | Phyllis Jackson | Speech-Language Pathologist | 9384 Florida Boulevard, Suite F, Walker, LA 70785 | 2007-01-17 |
| Street Address |
300 EVERGREEN DR SUITE 150 |
| City | GLEN MILLS |
| State | PA |
| Zip Code | 19342-1059 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568429793 | Dana Jo Gross | Occupational Therapist | 300 Evergreen Dr, Suite 220, Glen Mills, PA 19342-1059 | 2006-05-01 |
| 1285181693 | Christina Velazquez | Physical Therapist | 300 Evergreen Dr, Suite 220, Glen Mills, PA 19342-1059 | 2016-09-01 |
| 1619334984 | Lauren Dengler | Physical Therapist | 300 Evergreen Dr, Suite 220, Glen Mills, PA 19342-1059 | 2016-01-18 |
| 1205242849 | Shannon Bonini | Specialist/Technologist | 300 Evergreen Dr, Glen Mills, PA 19342-1059 | 2014-07-03 |
| 1427310663 | Julie Marie Blanchard | Physical Therapist | 300 Evergreen Dr, Suite 220, Glen Mills, PA 19342-1059 | 2012-06-13 |
| 1972875292 | Julia A Kasper | Internal Medicine | 300 Evergreen Dr, Suite 310, Glen Mills, PA 19342-1059 | 2012-02-01 |
| 1619296621 | Premier Orthopaedic and Sports Medicine Associates, Ltd | Durable Medical Equipment & Medical Supplies | 300 Evergreen Dr, Ste 200, Glen Mills, PA 19342-1059 | 2010-06-01 |
| 1962721480 | Premier Orthopaedic and Sports Medicine Associates, Ltd | Occupational Therapist | 300 Evergreen Dr, Ste 220, Glen Mills, PA 19342-1059 | 2010-05-24 |
| 1619105343 | Yamara Sheree Coutinho-sledge | Pediatrics | 300 Evergreen Dr, Suite 160, Glen Mills, PA 19342-1059 | 2009-07-01 |
| 1770711376 | Zachary T Mitchell | Physical Therapist | 300 Evergreen Dr, Ste 220, Glen Mills, PA 19342-1059 | 2009-06-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477038669 | Katherine Bilinski | Dietitian, Registered | 239 Winsor Court, Glen Mills, PA 19342 | 2018-10-03 |
| 1568969624 | Revathi Sangeetha Thirumaran | Nurse Anesthetist, Certified Registered | 24 Chamberlain Ct, Glen Mills, PA 19342 | 2018-04-06 |
| 1871098459 | Kristen Marie Rhodes | Counselor | 245 Bethel Road, Glen Mills, PA 19342 | 2018-03-27 |
| 1295256212 | Heart 2 Heart Home Care Agency | Home Health | 11 Mount Aire Farm Road, Glen Mills, PA 19342 | 2017-06-29 |
| 1285088385 | Christopher Clark | Occupational Therapist | 101 Applied Bank Blvd Ste D4, Glen Mills, PA 19342 | 2016-04-15 |
| 1528439742 | Dental Professionals of Pennsylvania, PC | Dentist | 1751 Wilmington Pike, Suite F-2, F-3, Glen Mills, PA 19342 | 2015-10-14 |
| 1760853246 | Wegmans Food Markets, Inc. | Pharmacy | 100 Applied Bank Blvd, Glen Mills, PA 19342 | 2015-10-09 |
| 1508289893 | Mandy Fadakar | Pharmacist | 700 Evergreen Drive, Glenn Mills, PA 19342 | 2014-01-23 |
| 1073944476 | Amanda M Hoffman | Behavioral Analyst | 4 Mohawk Court, Glen Mills, PA 19342 | 2013-12-10 |
| 1235576075 | Sarah E Tonelli | Dermatology | 500 Evergreen Dr Ste 20, Glen Mills, PA 19342 | 2013-06-03 |
| Find all providers in zip 19342 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780928499 | Shantel Lorraine Polchlopek | Physician Assistant | 500 Cheyney Road, Glen Mills, PA 19373 | 2012-11-19 |
| 1710041975 | Jenny Lucia Depadua | Physician Assistant | 1020 Baltimore Pike Ste 300, Glen Mills, PA 19342 | 2006-12-21 |
| 1780657080 | Erin M Doherty | Physician Assistant | 500 Evergreen Dr, Suite 20, Glen Mills, PA 19342-1032 | 2006-02-08 |
| 1841741287 | Kelly Mullan | Physician Assistant | 500 Cheyney Rd, Glen Mills, PA 19342-1805 | 2016-10-20 |
| 1699101055 | Jaclyn Marie Dematteis | Physician Assistant | 101 Applied Bank Blvd Ste 11, Glen Mills, PA 19342 | 2013-09-17 |
| 1255607677 | Theresa G Kueny | Physician Assistant | 500 Evergreen Dr, Suite 20, Glen Mills, PA 19342-1017 | 2012-03-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093316762 | Alyssa Ann Mikes | Physician Assistant | 6 New Countryside Dr, West Chester, PA 19382-6456 | 2020-11-08 |
| 1720689011 | Marissa Dawn Lamary | Physician Assistant | 1500 Fifth Ave Bldg Leveld, Mckeesport, PA 15132-2422 | 2020-11-04 |
| 1013517796 | Kifany M Gower | Physician Assistant | 1158 Wyoming Ave, Exeter, PA 18643-1815 | 2020-10-30 |
| 1922608645 | Meghan Michelle Allen | Physician Assistant | 4800 Friendship Ave Ste 439, Pittsburgh, PA 15224-1722 | 2020-10-30 |
| 1912507807 | Rachel Nye | Physician Assistant | 124 Home Depot Dr Ste D, Franklin, PA 16323-8030 | 2020-10-29 |
| 1487254306 | Zane T Mcguire | Physician Assistant | 378 W Chestnut St Ste 103, Washington, PA 15301-4661 | 2020-10-29 |
| 1740889443 | Tricia Harenza | Physician Assistant | 27 Sandy Ln Ste 250, Lewistown, PA 17044-1372 | 2020-10-22 |
| 1336748425 | Alexis Marie Ivosevic | Physician Assistant | 98 Deer Park Ln, Hawley, PA 18428-8223 | 2020-10-20 |
| 1780283986 | Margaret Ann Malloy | Physician Assistant | 3223 N Broad St Fl 1, Philadelphia, PA 19140-5007 | 2020-10-20 |
| 1851990170 | Jessica Marie Giordano | Physician Assistant | 201 Penn Valley Ter, Yardley, PA 19067-1028 | 2020-10-19 |
| Find all providers with the same taxonomy | ||||
| City | GLEN MILLS |
| Zip Code | 19342 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.