Laurena S Jackson, PHYSICIAN ASSISTANT

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

101493 Issued in NC

Practice address

300 Fountain Road
Rocky Mount, NC 27802

Phone

(252) 442-9712

Fax

(252) 442-1413

NPI assigned

Aug 19, 2008

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": "1219104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219104000000",
    "number": "1487801775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1713 SAGAMORE CT",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276044743",
            "telephone_number": "252-442-9712",
            "fax_number": "252-442-1413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 FOUNTAIN ROAD",
            "city": "ROCKY MOUNT",
            "state": "NC",
            "postal_code": "27802",
            "telephone_number": "252-442-9712",
            "fax_number": "252-442-1413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LAURENA",
        "middle_name": "S",
        "name_prefix": "Mrs.",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-19",
        "last_updated": "2008-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "101493",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura L Jacimore, MD
• Jackson & Company Holdings LLC
• Amirah Diane Jackson, DMD
• Darlene K Jackson, RD,LDN
• James Edward Jackson III
• Ancy Jacob
• Tonya Naketha Jacobs, CPHT
• James G. Crawford
• James Ohm, DMD, P.a.
• Janna Healthcare Services

• Medical Physician Assistant in Rocky Mount, NC
• Providers in Rocky Mount, NC by specialty
• Medical Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 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.