Active NPI
Cheryl Anne Jackson, NP
- Physician Assistant
- Huntington Mills, PA
National Provider Identifier
1831165166
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- VP005790B
- Practice address
- 401 Shickshinney Lake Road
Huntington Mills, PA 18622-0046 - Phone
- (570) 864-3191
- Fax
- (570) 864-2569
- NPI assigned
- Feb 27, 2006
- 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 | VP005790B | PA | Primary |
Addresses
Primary practice location
401 Shickshinney Lake Road
Huntington Mills, PA 18622-0046
Mailing address
16 Highland CT
Dallas, PA 18612-1237
Phone (570) 674-2268
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 50072326 | Other | PA | KEYSTONE CBC |
| 1019794280001 | Medicaid | PA |
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)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Emergency Care Services of Pennsylvania, P.C. | Physician Assistant | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Emergency Medicine Physician
- Wilkes Barre, PA
- NPI 1235374927
Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140998400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1257379200000",
"number": "1831165166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16 HIGHLAND CT",
"city": "DALLAS",
"state": "PA",
"postal_code": "186121237",
"telephone_number": "570-674-2268"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 SHICKSHINNEY LAKE ROAD",
"city": "HUNTINGTON MILLS",
"state": "PA",
"postal_code": "186220046",
"telephone_number": "570-864-3191",
"fax_number": "570-864-2569"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "CHERYL",
"middle_name": "ANNE",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-27",
"last_updated": "2009-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "PA",
"license": "VP005790B",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KEYSTONE CBC",
"identifier": "50072326",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1019794280001",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Huntington Mills, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 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.