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General NPI Number Information
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NPI Number | 1386977593
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Entity Type | Individual
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Provider Name | FRANK JAMES JACKSON JR. P.A-C., A.T.C.
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Gender | Male
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Dates
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Enumeration Date | 09/08/2009
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1250 S CEDAR CREST BLVD STE 110
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City | ALLENTOWN
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State | PA
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Zip | 18103-6224
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Country | US
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Telephone | 610-402-8900
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 MACK BLVD FL 4
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City | ALLENTOWN
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State | PA
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Zip | 18103-5622
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Country | US
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Telephone | 484-884-0469
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Fax | 484-884-0628
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2000001831
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA058371
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License Number State | PA
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