Individual
JACKSON ROSS SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2620 ARBOR DR, MCHENRY, IL 60050-2694
(815) 385-9877
Mailing address
2620 ARBOR DR, MCHENRY, IL 60050-2694
(815) 387-9877
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1236209
—
Other
Enumeration date
06/09/2025
Last updated
06/18/2025
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