Individual
CHERYL ANNE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
401 SHICKSHINNEY LAKE ROAD, HUNTINGTON MILLS, PA 18622-0046
(570) 864-3191
(570) 864-2569
Mailing address
16 HIGHLAND CT, DALLAS, PA 18612-1237
(570) 674-2268
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
VP005790B
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1019794280001
—
PA
01
—
50072326
KEYSTONE CBC
PA
Enumeration date
02/27/2006
Last updated
11/05/2009
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