LARRY D JACKSON (NPI# 1912928441) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912928441 |
| Entity Type | Individual |
| Full Name | LARRY D JACKSON |
| Credential | PA-C |
| Practice Address |
500 Gypsy Ln Youngstown OH 44504-1315 |
| Mailing Address |
16620 Downey Glen Trl Burton OH 44021-9319 |
| Practice Telephone | 3308841000 |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2014-11-20 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 146D00000X | Personal Emergency Response Attendant | 50000351 | OH | Emergency Medical Service Providers |
| Y | 363A00000X | Physician Assistant | 50-000351 | OH | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | MEDICARE TRAVELERS RR-GA | 970029949 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568855724 | Larry Jackson Jr. | Specialist/Technologist | 826 Warfield Pl, Lexington, KY 40505-3612 | 2015-03-12 |
| 1396186276 | Larry Tyler Jackson | Dentist | 14100 N 83rd Ave, Ste 280, Peoria, AZ 85381-5658 | 2013-07-08 |
| 1093878191 | Larry Randolph Jackson | Registered Nurse | 615 Rapids Rd, Columbia, SC 29212-3024 | 2006-12-19 |
| 1710068499 | Larry M. Jackson | Nutritionist | 9357 S Kingston Ave, Chicago, IL 60617-4042 | 2006-10-18 |
| 1093169062 | Larry Jackson Jr. | Counselor | 1420 Central Ave, Dubuque, IA 52001-4842 | 2016-04-15 |
| 1679971667 | Larry Jackson | Specialist | 1501 5th Ave N, St Petersburg, FL 33705-2008 | 2014-12-08 |
| 1578880548 | Larry Arthur Jackson | Family Medicine | 1445 Gateway Blvd, Cottage Grove, OR 97424-1224 | 2010-04-29 |
| 1023285582 | Larry Ronald Jackson II | Internal Medicine | 2301 Erwin Rd, Durham, NC 27710-0001 | 2008-05-14 |
| 1275574295 | Larry K Jackson | Internal Medicine | 2660 10th Ave S, Suite 528, Birmingham, AL 35205-1605 | 2006-06-09 |
| 1720049349 | Larry Jackson | Family Medicine | 6565 W Main St, Kalamazoo, MI 49009-6114 | 2006-03-31 |
| Street Address |
500 GYPSY LN |
| City | YOUNGSTOWN |
| State | OH |
| Zip Code | 44504-1315 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205838497 | Pediatric Imaging Associates, LLC | Specialist | 500 Gypsy Ln, Youngstown, OH 44504-1315 | 2005-06-01 |
| 1245899772 | Eric Laurence Trevizo | Student in an Organized Health Care Education/Training Program | 500 Gypsy Ln, Youngstown, OH 44504-1315 | 2019-06-09 |
| 1891258968 | Shyam Krishna Poudel | Student in an Organized Health Care Education/Training Program | 500 Gypsy Ln, Youngstown, OH 44504-1315 | 2019-04-07 |
| 1518429711 | Allen Tsai | Student in an Organized Health Care Education/Training Program | 500 Gypsy Ln, Youngstown, OH 44504-1315 | 2019-04-05 |
| 1174084420 | Poonam Nayyer Choudhry | Student in an Organized Health Care Education/Training Program | 500 Gypsy Ln, Youngstown, OH 44504-1315 | 2019-03-28 |
| 1093276552 | Brittany Raisa Cools-lartigue | Student in an Organized Health Care Education/Training Program | 500 Gypsy Ln, Youngstown, OH 44504-1315 | 2019-03-27 |
| 1104386176 | Noha Nabil Nasif Soror | Student in an Organized Health Care Education/Training Program | 500 Gypsy Ln, Youngstown, OH 44504-1315 | 2019-03-25 |
| 1871053223 | Jakob Anthony Weaver | Student in an Organized Health Care Education/Training Program | 500 Gypsy Ln, Youngstown, OH 44504-1315 | 2019-03-21 |
| 1245790807 | Emma Sayre | Student in an Organized Health Care Education/Training Program | 500 Gypsy Ln, Youngstown, OH 44504-1315 | 2019-03-20 |
| 1639638596 | Erik Sven Coopes | Student in an Organized Health Care Education/Training Program | 500 Gypsy Ln, Youngstown, OH 44504-1315 | 2019-03-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003458845 | Shay Kahani | Social Worker | 517 Gypsy Lane, Youngstown, OH 44504 | 2019-10-14 |
| 1497312573 | Parth Shah | Student in an Organized Health Care Education/Training Program | Western Reserve Health Education, 500 Gypsy Lane, Medical Office Building A, Youngstown, OH 44504 | 2019-05-23 |
| 1811455348 | Kisha Brady | Nurse Practitioner | 1350 Belmont Ave, Youngstown, OH 44504 | 2019-03-04 |
| 1750808473 | Janae White | Home Health | 2278 Cordova Ave, Youngstown, OH 44504 | 2017-08-23 |
| 1760910509 | Ryan Gallagher | Student in an Organized Health Care Education/Training Program | 1001 Covington Ave, Youngstown, OH 44504 | 2017-05-24 |
| 1649727314 | Bilal Abo Almakarim Kanawati | Specialist/Technologist, Other | 461 Gypsy Ln Apt 72, Youngstown, OH 44504 | 2016-09-09 |
| 1174979157 | Hiyam Abdelmagid | Internal Medicine | 1001 Covington Ave., Youngstown, OH 44504 | 2016-05-10 |
| 1962696419 | Earnest Perry, M.d., Inc. | Surgery | 1320 Belmont Avenue, Ste 2, Youngstonw, OH 44504 | 2007-08-28 |
| 1699839738 | Rodney Earl Hill | Family Medicine | 1350 Fifth Ave, Suite 324, Youngstown, OH 44504 | 2006-12-21 |
| 1710063987 | David A Hoffman | Internal Medicine | 1220 Belmont Avenue, Youngstown, OH 44504 | 2006-10-31 |
| Find all providers in zip 44504 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225664584 | Jaclyn Taylor Jones | Physician Assistant | 1001 Belmont Ave Ste C, Youngstown, OH 44504-1003 | 2020-03-19 |
| 1629356837 | Miquita C Hosey | Physician Assistant | 238 S Meridian Rd, Youngstown, OH 44509-2925 | 2011-07-22 |
| 1497725188 | Jocelyn Rae Kimmel | Physician Assistant | 1001 Belmont Ave, Youngstown, OH 44504-1003 | 2006-01-25 |
| 1841296084 | Craig A Morrison | Physician Assistant | 540 Parmalee Ave Ste 510, Youngstown, OH 44510-1605 | 2005-06-22 |
| 1255979779 | Rajendra P Koirala, M.d., LLC | Physician Assistant | 725 Boardman Canfield Rd Ste L1, Youngstown, OH 44512-4370 | 2019-12-16 |
| 1093350688 | Sofia Accordino | Physician Assistant | 1044 Belmont Ave, Youngstown, OH 44504-1006 | 2019-11-07 |
| 1265076764 | Tyler Tsangaris-braatz | Physician Assistant | 1044 Belmont Ave, Youngstown, OH 44504-1006 | 2019-10-29 |
| 1770125262 | Nicolette Marie Arnoto | Physician Assistant | 1044 Belmont Ave, Youngstown, OH 44504-1006 | 2019-10-16 |
| 1598249765 | Victoria Danielle Puckett | Physician Assistant | 1001 Belmont Ave, Youngstown, OH 44504-1003 | 2018-09-24 |
| 1932687522 | Taylor Marie Murphy | Physician Assistant | 1340 Belmont Ave, Youngstown, OH 44504-1125 | 2018-08-06 |
| Find all providers in YOUNGSTOWN | ||||
| City | YOUNGSTOWN |
| Zip Code | 44504 |
Please comment or provide details below to improve the information on LARRY D JACKSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.