Individual
AUTUMN A JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MHS, PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
0110002073
VA
363AM0700X
Medical Physician Assistant
Primary
C0003077
MD
Other
Enumeration date
05/23/2006
Last updated
07/11/2011
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