SARA JACKSON (NPI# 1295123602) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295123602 |
| Entity Type | Individual |
| Full Name | SARA JACKSON |
| Practice Address |
200 Medical Park Blvd Petersburg VA 23805-9274 |
| Mailing Address |
3264 Advance Mills Rd Ruckersville VA 22968-3209 |
| Practice Telephone | 8047655000 |
| Mailing Telephone | 7576514015 |
| Enumeration Date | 2015-01-07 |
| Last Update Date | 2015-01-07 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730713926 | Sara Jackson | Behavior Technician | 15 Seagroves St, Wilton, NH 03086 | 2020-02-26 |
| 1194342436 | Sara Jackson | Social Worker | 2029 Buchanan St, Kansas City, MO 64116 | 2020-07-02 |
| 1023632080 | Sara Anne Pili Jackson | Counselor | 1274 Center Court Dr Ste 112, Covina, CA 91724-3668 | 2020-06-04 |
| 1689223646 | Sara L Jackson | Registered Nurse | 16453 Bear Valley Rd, Hesperia, CA 92345-1752 | 2019-09-11 |
| 1710546106 | Sara Jackson | Dentist | 8217 Wicker Ave, Saint John, IN 46373-8878 | 2019-06-10 |
| 1629560495 | Sara Elizabeth Jackson | Behavior Technician | 231 Se Barrington Dr Ste 203, Oak Harbor, WA 98277-3200 | 2018-06-06 |
| 1548758972 | Sara Michelle Jackson | Behavior Technician | 6210 75th St W Ste B100, Lakewood, WA 98499-8109 | 2018-05-01 |
| 1992205108 | Sara Izora Jackson | Social Worker | 5310 Ball Camp Pike, Knoxville, TN 37921-3234 | 2018-02-14 |
| 1013312487 | Sara Ann Jackson | Registered Nurse | 1969 W Hart Rd, Beloit Health System Inc, Beloit, WI 53511-2230 | 2014-10-28 |
| 1114366945 | Sara W. Jackson | Occupational Therapist | 1201 Broad Rock Blvd, Pm&r/117, Richmond, VA 23249-0001 | 2013-06-14 |
| Street Address |
200 MEDICAL PARK BLVD |
| City | PETERSBURG |
| State | VA |
| Zip Code | 23805-9274 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902413636 | Delesa Shana Kay Walden | Registered Nurse | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2020-09-27 |
| 1992339436 | Amy Kathryn Lansing | Physician Assistant | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2020-02-24 |
| 1588296453 | Erin Elise Layne | Physician Assistant | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2020-02-10 |
| 1295374643 | Crystal Leigh Maddox | Physical Therapist | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2020-01-02 |
| 1366081911 | Joshua Paul Pidcoe | Physician Assistant | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2019-12-31 |
| 1720623853 | Bon Secours Mercy Health Petersburg LLC | General Acute Care Hospital | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2019-11-13 |
| 1144874686 | Nina Thi Ong-pham | Physician Assistant | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2019-08-01 |
| 1720543507 | Martina Rochelle Washington | Specialist/Technologist, Other | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2019-02-05 |
| 1356812242 | Ams Virginia Pllc | Nurse Anesthetist, Certified Registered | 200 Medical Park Blvd, Petersburg, VA 23805 | 2018-12-17 |
| 1841761079 | Erin Collins | Physician Assistant | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2018-12-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134690647 | Miles Viant | Occupational Therapist | 287 E Blvd, Petersburg, VA 23805 | 2018-12-10 |
| 1245756964 | Dexter Shabazz Lett | Registered Nurse | 10543 S. Crater Rd, S. Prince George, VA 23805 | 2017-08-15 |
| 1891145876 | Taylor Enhanced Living | Counselor | 105 Holly Hill Dive, Suite A, Petersburg, VA 23805 | 2016-06-21 |
| 1700255205 | Ina Thompson | Counselor | 272 Medical Park Boulevard, Petersburg, VA 23805 | 2015-09-15 |
| 1932582541 | Valeria Edda Madrid Malo Bohorquez | Internal Medicine | 50 Medical Park Blvd Ste C, Petersburg, VA 23805 | 2015-06-30 |
| 1548642788 | Justin Andrew Phillingane | Podiatrist | 3335 S Crater Rd Ste 500, Petersburg, VA 23805 | 2015-06-24 |
| 1225417082 | Paladin Dermatology LLC | Nurse Practitioner | 44 A& B Medical Park Blvd, Petersburg, VA 23805 | 2015-05-27 |
| 1245652544 | Family Services Inc. | Health Maintenance Organization | 1045 Gustavo Lane, Petersburg, VA 23805 | 2014-01-06 |
| 1619268075 | Charlene Belangia | Massage Therapist | 3323 S. Crater Rd, Suite B, Petersburg, VA 23805 | 2011-04-20 |
| 1760709638 | Caresouth Hha Holdings of Virginia, LLC | Home Health | 34 Medical Park Boulevard, Suite G-h, Petersburg, VA 23805 | 2010-04-30 |
| Find all providers in zip 23805 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528473485 | Alexander Long | Physician Assistant | 40 Medical Park Blvd, Ste B, Petersburg, VA 23805-9289 | 2014-06-30 |
| 1174940886 | Shrinal Suryakant Patel | Physician Assistant | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2014-03-20 |
| 1174948889 | Krysten M Bishop | Physician Assistant | 200 Medical Park Blvd, Petersburg, VA 23805 | 2014-03-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124638986 | Courtney Anne Kassner | Physician Assistant | 2706 Davis Ave, Alexandria, VA 22302-2817 | 2020-08-06 |
| 1295356145 | Nilofar Ariasaif | Physician Assistant | 15401 Bald Eagle Ln, Woodbridge, VA 22191-3782 | 2020-05-01 |
| 1396366555 | Sheelon Aghili | Physician Assistant | 5801 Hampton Forest Way, Fairfax, VA 22030-7254 | 2020-04-29 |
| 1679102347 | Mary Herrera | Physician Assistant | 6353 Center Dr Ste 204, Norfolk, VA 23502-0001 | 2020-04-05 |
| 1720614019 | Andrew James Meyers | Physician Assistant | 229 W Bute St Apt 207, Norfolk, VA 23510-1415 | 2020-03-18 |
| 1902432644 | Madison Alexis Cooper | Physician Assistant | 920 Battlefield Blvd S Ste 101, Chesapeake, VA 23322-4254 | 2020-03-13 |
| 1285296111 | Kimberly Stewart Hugo | Physician Assistant | 10932 Point Grey Road, Henrico, VA 23233-2429 | 2019-07-01 |
| 1558824698 | Jessica Leigh Pacuch | Physician Assistant | 2440 Raphine Rd, Raphine, VA 24472-2541 | 2019-04-06 |
| 1073074431 | Nicholas Alexander Jones | Physician Assistant | 924 Parley Pl, Chesapeake, VA 23323-4135 | 2019-03-28 |
| 1003371410 | Ryan Timothy Pyles | Physician Assistant | 25 Commerce Park Drive, Raphine, VA 24472 | 2019-02-11 |
| Find all providers with the same taxonomy | ||||
| City | PETERSBURG |
| Zip Code | 23805 |
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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.