Healthcare Provider Details

I. General information

NPI: 1609470517
Provider Name (Legal Business Name): RACHEL HIL JACKSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 SPRUCE ST FL 3
PHILADELPHIA PA
19107-5701
US

IV. Provider business mailing address

801 SPRUCE ST FL 3
PHILADELPHIA PA
19107-5701
US

V. Phone/Fax

Practice location:
  • Phone: 215-829-2222
  • Fax: 215-829-2492
Mailing address:
  • Phone: 215-829-2222
  • Fax: 215-829-2492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA062140
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: