Kaylyn A Jackson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110005201 Issued in VA

Practice address

2001 Crystal Spring Ave SW Ste 201
Roanoke, VA 24014-2465

Phone

(540) 853-0100

NPI assigned

Jan 19, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Kaylyn Price Former name

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Carilion Medical CenterGroup PAC ID 9830096585, 956 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Carilion Medical Center Hospital, Roanoke, VA, CCN 490024

Merit-based Incentive Payment System (MIPS)

Final score

88.36 of 100Reported as group

Quality

81.36

Promoting interoperability

100

Improvement activities

40

Cost

74.56

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kjackson857691@direct.hfhs.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Carilion Medical Center

  • Multi-Specialty Clinic/Center
  • Roanoke, VA
  • NPI 1730123472
  Medicare reassignment Care Compare group NPD
• Bon Secours Medical Group Richmond Specialty Care LLC

  • Cardiovascular Disease Physician
  • Richmond, VA
  • NPI 1477112225
  Medicare reassignment NPD
• Bon Secours Medical Group Richmond Specialty Care LLC

  • Durable Medical Equipment & Medical Supplies
  • Midlothian, VA
  • NPI 1841029287
  NPD
• Carilion Medical Center

  • Durable Medical Equipment & Medical Supplies
  • Hardy, VA
  • NPI 1073324810
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Carilion Medical Center

  • General Acute Care Hospital
  • Roanoke, VA
  • NPI 1033102942
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1453161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755216000000",
    "number": "1104283365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 S JEFFERSON ST STE 1006",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240111713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 CRYSTAL SPRING AVE SW STE 201",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240142465",
            "telephone_number": "540-853-0100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 E Michigan Ave",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MI",
            "postal_code": "492011847",
            "country_code": "US",
            "telephone_number": "517-205-4800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1221 Lee St",
            "address_2": "2nd Floor",
            "address_purpose": "LOCATION",
            "city": "Charlottesville",
            "state": "VA",
            "postal_code": "229080001",
            "country_code": "US",
            "telephone_number": "434-924-5052",
            "fax_number": "434-844-7588",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KAYLYN",
        "middle_name": "A",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-19",
        "last_updated": "2025-08-15",
        "certification_date": "2025-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601011711",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "VA",
            "license": "0110-005201",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110005201",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1104283365",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAYLYN",
            "last_name": "PRICE",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jasmine Yvette Jackson-Akers, DO
• Beja Jackson
• Bobbie Jackson, MSN, APRN, AGACNP-BC
• Brooke Ware Jackson
• John B Jackson
• Kyler Jackson
• Samuel Robert Jackson, PA
• Shamani Jackson
• Shana Jackson, LCSW
• Carol Jacobs, DPT

• Physician Assistant in Roanoke, VA
• Providers in Roanoke, VA by specialty
• Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.