Individual
LAUREN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2830 CRESCENT AVE, EUGENE, OR 97408-7397
(541) 686-9000
Mailing address
PO BOX 35380, LAS VEGAS, NV 89133-5380
(702) 579-3203
(702) 838-1456
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2490
OK
363A00000X
Physician Assistant
Primary
—
OR
363AS0400X
Surgical Physician Assistant
2490
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200572730A
—
OK
Enumeration date
01/13/2015
Last updated
09/25/2025
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