Individual
LAUREN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
100 MICHIGAN ST NE, GRAND RAPIDS, MI 49503-2560
(616) 460-5914
Mailing address
4100 EMBASSY DR SE STE 200, GRAND RAPIDS, MI 49546-2416
(616) 988-8220
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601010413
MI
363AM0700X
Medical Physician Assistant
5601010413
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5601010413
—
MI
Enumeration date
02/15/2021
Last updated
07/28/2026
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