# PAMELA LEE JACKSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1619905072
- **Gender:** F
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | 42-0008559 | VT | Yes |

## Other

- **Enumeration date:** 06/28/2006
- **Last updated:** 01/08/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | E01148865 | — | NY |
| 05 | — | OVN0393 | — | VT |