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DERRELL GLENN JACKSON PA-C
NPI 1104072297
Physician Assistant in Colonial Heights, VA

Active since August 08, 2008
436 CLAREMONT CT, SUITE 100, COLONIAL HEIGHTS, VA 23834(804) 526-2121(804) 520-2617 Get Directions Write a Review

NPPES record last updated: May 26, 2010. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Derrell Glenn Jackson Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DERRELL GLENN JACKSON PA-C (NPI 1104072297) is an individual physician assistant in Colonial Heights, Virginia, licensed in Virginia (0110002804) and active in the NPI registry since August 2008.

NPPES Registry Identity

NPI1104072297
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameDERRELL GLENN JACKSONCredential: PA-C
Location Address436 CLAREMONT CT, SUITE 100Colonial Heights, VA 23834-1765
Mailing Address205 Misty Ridge LnSuffolk, VA 23434-1516 · (757) 406-7328
Phone(804) 526-2121
Fax(804) 520-2617
Sole ProprietorNo
Enumeration DateAugust 8, 2008
Last NPPES UpdateMay 26, 2010
✔ NPI 1104072297 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in VA · 0110002804
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
Also ListedPhysician Assistant · MedicalTaxonomy 363AM0700X · License 0110002804 (VA)
436 CLAREMONT CT, Colonial Heights, VA 23834
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Other Identifiers 6

Other10040880PVA · Optima
OtherP00685057VA · Rr Medicare
Medicaid1104072297VA
Medicare PINMC12468VA
Other10040880PVA · Sentara Healthcare
Medicare PINMC12210VA

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CLARK CURTIS HUNT MD
Family Medicine
436 CLAREMONT CT, SUITE 100
COLONIAL HEIGHTS, VA 23834
Colonial Heights City (804) 526-2121
PETERSBURG CLINIC COMPANY, LLC
Family Medicine
436 CLAREMONT CT, SUITE 100
COLONIAL HEIGHTS, VA 23834
Colonial Heights City (804) 526-2121
PETERSBURG HOSPITAL COMPANY LLC
Clinic/Center (Community Health)
436 CLAREMONT CT
COLONIAL HEIGHTS, VA 23834
Colonial Heights City (804) 862-5000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Derrell Jackson's NPI number?

The NPI number for Derrell Jackson is 1104072297. It was assigned to this individual provider in the NPPES registry on August 8, 2008.

Where is Derrell Jackson located?

Derrell Jackson practices at 436 Claremont Ct Suite 100, Colonial Heights, VA 23834. The listed phone number is (804) 526-2121.

What is Derrell Jackson's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

When was this NPI record last updated?

The NPPES record for Derrell Jackson was last updated on May 26, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.