Donald J. Jackson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

055-0030673 Issued in VT

Practice address

185 Grafton Rd.
Townshend, VT 05353

Phone

(802) 365-4331

NPI assigned

Sep 27, 2006

Last updated

Jul 9, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215561600000",
    "number": "1407947039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 216",
            "address_2": "185 GRAFTON RD.",
            "city": "TOWNSHEND",
            "state": "VT",
            "postal_code": "053530216",
            "telephone_number": "802-365-4331",
            "fax_number": "802-365-7031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 GRAFTON RD.",
            "city": "TOWNSHEND",
            "state": "VT",
            "postal_code": "05353",
            "telephone_number": "802-365-4331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DONALD",
        "middle_name": "J.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2008-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VT",
            "license": "055-0030673",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OAP1167",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Townshend, VT
• Providers in Townshend, VT by specialty
• Physician Assistant in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2008; 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.