Healthcare Provider Details

I. General information

NPI: 1427975242
Provider Name (Legal Business Name): CHRISTOPHER JACKSON PARAMEDIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JSOMTC BLDG 5-3845 COMBAT MEDIC DR
FORT BRAGG NC
28310-0001
US

IV. Provider business mailing address

111 HONOR LN
BUNNLEVEL NC
28323-9229
US

V. Phone/Fax

Practice location:
  • Phone: 330-835-8323
  • Fax:
Mailing address:
  • Phone: 330-835-8323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberM5077003
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: