Hazel Jackson, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

0110002755 Issued in VA

Practice address

7502 Justice Dr
Gloucester, VA 23061-6101

Phone

(804) 693-1090

Fax

(804) 693-1093

NPI assigned

Sep 11, 2009

Last updated

Sep 11, 2009By the provider in NPPES

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1252627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1252627200000",
    "number": "1457684284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7502 JUSTICE DR",
            "city": "GLOUCESTER",
            "state": "VA",
            "postal_code": "230616101",
            "telephone_number": "804-693-1090",
            "fax_number": "804-693-1093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7502 JUSTICE DR",
            "city": "GLOUCESTER",
            "state": "VA",
            "postal_code": "230616101",
            "telephone_number": "804-693-1090",
            "fax_number": "804-693-1093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "HAZEL",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-11",
        "last_updated": "2009-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110002755",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Raven Hundley
• Kristy A Hunter, ATC
• Karina Iashchenko
• Integrated Dermatology of Gloucester, LLC
• Valerie Iovino, LCSW
• Erin E. Jasenak, PT, DPT
• Jenny Skeen John, LPC
• Joshua Johnson, LPC
• Madelyn Johnson
• Susan Johnson

• Medical Physician Assistant in Gloucester, VA
• Providers in Gloucester, VA by specialty
• Medical Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2009; 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.