MRS. SAMANTHA JACKSON (NPI# 1801191754) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801191754 |
| Entity Type | Individual |
| Full Name | MRS. SAMANTHA JACKSON |
| Credential | PAC |
| Practice Address |
1818 Richardson Dr Reidsville NC 27320-5451 |
| Practice Telephone | 3363495040 |
| Practice Fax Number | 3363695366 |
| Mailing Telephone | 3363495040 |
| Mailing Fax Number | 3363695366 |
| Enumeration Date | 2011-01-24 |
| Last Update Date | 2013-08-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 0010-02724 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 89163RE | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649804360 | Samantha Jackson | Home Health Aide | 920 Waycross Rd, Cincinnati, OH 45240-3071 | 2020-03-03 |
| 1215408489 | Samantha Jackson | Licensed Vocational Nurse | 6100 Ashbury St Apt 3114, North Richland Hills, TX 76180-2010 | 2018-12-16 |
| 1861960221 | Samantha Rae Jackson | Nurse Practitioner | 320 Sumner Blvd, Collinsville, IL 62234-1929 | 2018-11-05 |
| 1104806967 | Samantha Jackson | Family Medicine | 415 W Forest Ln, Hobart, OK 73651-1645 | 2006-01-18 |
| 1710527387 | Samantha Jackson | Behavior Technician | 21230 Kingsland Blvd Ste 100a, Katy, TX 77450-5899 | 2020-01-13 |
| 1609438225 | Samantha Lachelle Jackson | Counselor | 1900 N Howard St Ste 300, Baltimore, MD 21218-5909 | 2019-07-03 |
| 1245607357 | Samantha Rae Jackson | Counselor | 695 South St, Chardon, OH 44024-1474 | 2015-08-24 |
| 1174906549 | Samantha L Jackson | Counselor | 1470 Civic Ct Ste 110, Concord, CA 94520-5290 | 2015-07-03 |
| 1558615583 | Samantha Jackson | Speech-Language Pathologist | 4609 San Dario Ave Ste 9, Laredo, TX 78041-5773 | 2012-10-29 |
| 1457652489 | Samantha R. Jackson | Licensed Practical Nurse | 5285 Lewiston Rd, Lewiston, NY 14092-1942 | 2010-11-08 |
| Street Address |
1818 RICHARDSON DR |
| City | REIDSVILLE |
| State | NC |
| Zip Code | 27320-5451 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255334181 | Belmont Medical Associates Pllc | Internal Medicine | 1818 Richardson Dr, Ste A, Reidsville, NC 27320-5450 | 2005-05-24 |
| 1275997546 | Laboratory Corporation of America Holdings | Clinical Medical Laboratory | 1818 Richardson Dr, Suite C, Reidsville, NC 27320-5451 | 2016-04-12 |
| 1649600024 | Moses Cone Physician Services, Inc | Urology | 1818 Richardson Dr, Ste F, Reidsville, NC 27320-5451 | 2013-11-20 |
| 1639312879 | Northern Triad Surgical Associates, Pllc | Surgery | 1818 Richardson Dr, Ste. E, Reidsville, NC 27320-5451 | 2009-04-17 |
| 1417113424 | Mark A. Jenkins, Md | Specialist | 1818 Richardson Dr, Suite E, Reidsville, NC 27320-5451 | 2008-07-30 |
| 1982868865 | Junell Carol Koberlein | Family Medicine | 1818 Richardson Dr, Ste. A, Reidsville, NC 27320-5451 | 2008-07-10 |
| 1952595373 | Benjamin L Mann | Physician Assistant | 1818 Richardson Dr, Suite A, Reidsville, NC 27320-5451 | 2007-08-29 |
| 1629092184 | Mark A Jenkins | Surgery | 1818 Richardson Dr, Suite E, Reidsville, NC 27320-5451 | 2006-07-27 |
| 1750317665 | William Stanford Kallam | Dentist | 1818 Richardson Dr, Suite D, Reidsville, NC 27320-5451 | 2006-06-23 |
| 1700825486 | Brent Christian Ziegler | Surgery | 1818 Richardson Dr, Suite E, Reidsville, NC 27320-5450 | 2006-06-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417576620 | Professional Vision Care, Od, Pllc | Optometrist | 1624 Nc #14 Highway, Reidsville, NC 27320 | 2020-04-09 |
| 1538796966 | Dabney Varner Porter | Speech-Language Pathologist | 613 S. Main St., Reidsville, NC 27320 | 2020-03-25 |
| 1053868463 | Marlon Nolen | Social Worker | 425 Nc-65, Reidsville, NC 27320 | 2016-09-01 |
| 1659741346 | Gepernard Tania Polidor | Social Worker | 405 Nc-65, Reidsville, NC 27320 | 2015-10-07 |
| 1548687064 | Angel Allen | Skilled Nursing Facility | 255 Penn Lake Dr, Reidsville, NC 27320 | 2014-03-21 |
| 1801234844 | Remmsco | Substance Abuse Rehabilitation Facility | 106 N. Franklin St, Reidsville, NC 27320 | 2013-06-12 |
| 1861733669 | The Free Clinic of Rockingham County, Inc | Clinic/Center | 315 S. Main Street, Reidsville, NC 27320 | 2013-03-05 |
| 1396094173 | Helen Elizabeth Brooks | Nurse Practitioner | 502 South Scales Street, Reidsville, NC 27320 | 2012-09-07 |
| 1952650327 | Ashlee Place | Assisted Living Facility | 538 Warriner Street, Reidsville, NC 27320 | 2012-08-31 |
| 1558638536 | Tracey Caroline Cook | Pharmacist | 1623 Way, Reidsville, NC 27320 | 2011-11-19 |
| Find all providers in zip 27320 | ||||
| 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 |
|---|---|---|---|---|
| 1972502987 | Shannon G Mcelroy | Physician Assistant | 315 S Main St, Reidsville, NC 27320-3815 | 2005-07-20 |
| 1104338094 | Michael Charles Depasquale | Physician Assistant | 1818 Richardson Dr Ste A, Reidsville, NC 27320-5450 | 2017-10-31 |
| 1578074936 | Misty Ellen Stills | Physician Assistant | 405 Nc Highway 65, Reidsville, NC 27320-8882 | 2017-10-12 |
| 1528340163 | Lisa Webster | Physician Assistant | 217 Turner Dr Ste F, Reidsville, NC 27320-5754 | 2011-09-09 |
| 1952595373 | Benjamin L Mann | Physician Assistant | 1818 Richardson Dr, Suite A, Reidsville, NC 27320-5451 | 2007-08-29 |
| 1104994813 | Leslie Sharp Lewis | Physician Assistant | 233 Gilmer St, Reidsville, NC 27320-3809 | 2006-12-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215538459 | Sarah Jane Lamanna | Physician Assistant | 3012 Bristol Creek Dr, Morrisville, NC 27560-7811 | 2020-11-04 |
| 1043819741 | Brad Russell Tolan | Physician Assistant | 211 Pinegate Cir Apt 12, Chapel Hill, NC 27514-2221 | 2020-10-22 |
| 1265030654 | Vanessa Vinson | Physician Assistant | 284 Lower Edgewood Rd, Candler, NC 28715-9285 | 2020-10-16 |
| 1649878810 | Courtney Michelle Watlington | Physician Assistant | 360 N Bennett St, Southern Pines, NC 28387-4813 | 2020-10-11 |
| 1669079034 | Christine Meyer | Physician Assistant | 2523 Creek Ridge Ln, Chapel Hill, NC 27514-7454 | 2020-10-07 |
| 1407453319 | Khyan Waddell | Physician Assistant | 127 Sneed Rd, Enfield, NC 27823-9589 | 2020-10-04 |
| 1053918979 | Amjad Ali | Physician Assistant | 730 Montlieu Ave, High Point, NC 27260-4000 | 2020-10-04 |
| 1104433382 | Aditi Bhattacharjee Sundaresan | Physician Assistant | 131 Mallard Ct, Chapel Hill, NC 27517-9104 | 2020-09-30 |
| 1689281933 | Kathryn Tarulli | Physician Assistant | 600 W Main St Apt 624, Durham, NC 27701-5005 | 2020-09-29 |
| 1205443991 | Kelsey Mendez | Physician Assistant | 105 Basket Oak Dr, Bunnlevel, NC 28323-9141 | 2020-09-26 |
| Find all providers with the same taxonomy | ||||
| City | REIDSVILLE |
| Zip Code | 27320 |
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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.