Susan Jackson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA10004068 Issued in WA

Practice address

1629 N 45TH St
Seattle, WA 98103-6701

Phone

(206) 633-3350

Fax

(206) 633-3113

NPI assigned

Nov 2, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1205914314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 SPRUCE ST",
            "address_2": "STE. 300",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981042474",
            "telephone_number": "206-461-6935",
            "fax_number": "206-461-8382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1629 N 45TH ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981036701",
            "telephone_number": "206-633-3350",
            "fax_number": "206-633-3113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SUSAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA10004068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sean Michael Jackson, MA, LMHC
• Shannon Regina Jackson, NP-C
• Sharmell Jackson, CPC
• Shaun William Jackson, MD
• Stacy Latrice Jackson
• Susan Varner Jackson, PA-C
• Suzanne E Jackson, AU.D.
• Tamara E Jackson, P.A.
• Tyler Jackson
• Zultsetseg Wagner Jackson, PA-C

• Physician Assistant in Seattle, WA
• Providers in Seattle, WA by specialty
• Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.