Active NPI
Lydia Lane Jackson, PA C
- Physician Assistant
- Montgomery, AL
National Provider Identifier
1487642161
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA198
- Practice address
- 215 Perry Hill Rd
Montgomery, AL 36109-3725 - Phone
- (334) 272-4670
- NPI assigned
- Oct 7, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA198 | AL | Primary |
Addresses
Primary practice location
215 Perry Hill Rd
Montgomery, AL 36109-3725
Mailing address
7028 Cross Bend CT
Montgomery, AL 36117-2445
Phone (334) 213-6441
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA198 | AL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128643200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184284800000",
"number": "1487642161",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7028 CROSS BEND CT",
"city": "MONTGOMERY",
"state": "AL",
"postal_code": "361172445",
"telephone_number": "334-213-6441"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "215 PERRY HILL RD",
"city": "MONTGOMERY",
"state": "AL",
"postal_code": "361093725",
"telephone_number": "334-272-4670"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "LYDIA",
"middle_name": "LANE",
"credential": "PA C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-10-07",
"last_updated": "2007-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "AL",
"license": "PA198",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Montgomery, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 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.