Individual
MRS. LAURA RAE JACKAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
4975 FOOTE RD., STE. #400, MEDINA, OH 44256-9048
(330) 591-9038
(330) 722-8585
Mailing address
2000 AUBURN DR., STE. 350, BEACHWOOD, OH 44122-4327
(440) 646-1600
(440) 646-1505
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.008854RX
OH
363A00000X
Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0081746
—
OH
Enumeration date
01/04/2023
Last updated
10/21/2025
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