Pamela Kenna Jackson
Individual provider Active NPI Driver · Union, NJ
NPI 1013482439 · NPPES record last updated Jan 9, 2024
Key facts
- NPI
- 1013482439
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- License
- J00626147258862 (NJ)
- Practice address
- 1496 Village Rd Apt a
Union, NJ 07083-4461 - Phone
- (201) 284-2307
- NPI assigned
- Oct 12, 2018
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| J00626147258862 | NJ | MD | Driver |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| All Around Town Transportation LLC | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver |
172A00000X | J00626147258862 | NJ | Yes |
Addresses
Primary practice location
1496 Village Rd Apt a
Union, NJ 07083-4461
Mailing address
1496 Village Rd Apt a
Union, NJ 07083-4461
Phone (201) 284-2307
Other providers in Union, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 9, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.