Individual
KAYLYN A JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2001 CRYSTAL SPRING AVE SW STE 201, ROANOKE, VA 24014-2465
(540) 853-0100
Mailing address
213 S JEFFERSON ST STE 1006, ROANOKE, VA 24011-1713
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110005201
VA
363A00000X
Physician Assistant
5601011711
MI
363AS0400X
Surgical Physician Assistant
0110-005201
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104283365
—
VA
Enumeration date
01/19/2016
Last updated
08/15/2025
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