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General NPI Number Information
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NPI Number | 1588710727
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Entity Type | Individual
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Provider Name | JAMIE S JACKLING PA
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Gender | Female
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Dates
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Enumeration Date | 01/27/2007
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Last Update Date | 02/05/2019
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Provider Practice Location Address
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Address Line | 104 ENDICOTT ST STE LL00
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City | DANVERS
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State | MA
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Zip | 01923-3623
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Country | US
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Telephone | 297-888-2690
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Fax |
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Provider Business Mailing Address
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Address Line | 104 ENDICOTT ST STE LL00
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City | DANVERS
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State | MA
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Zip | 01923-3623
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Country | US
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Telephone | 978-882-6902
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2192
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License Number State | MA
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