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NPI Code Detail

MEDICARE: KAREN T JACKSON PA-C

MEDICARE: KAREN T JACKSON PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantMA061162PA
2363A00000XPhysician Assistant0110005884VA
3363A00000XPhysician AssistantPA9115486FL

General Provider Information

NPI Number : 1558876680
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAREN T JACKSON PA-C
Provider Business Mailing Address
First Line : 1210 S OLD DIXIE HWY
Second Line :
City : JUPITER
State : FL
Zip : 33458-7205
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1210 S OLD DIXIE HWY
Second Line :
City : JUPITER
State : FL
Zip : 33458-7205
Country : US
Telephone Number : 561-263-2234
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2017
Last Update Date : 06/24/2026

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