Jackson, Larry D

Jackson, Larry D is an sole proprietor health care provider with primary practice located at 500 Gypsy Ln , Youngstown OH 44504-1315. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Emergency Medical Service Providers / Personal Emergency Response Attendant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Jackson, Larry D can be contacted via phone (330) 884-1000.

Contact Information

Primary practice address
500 Gypsy Ln Youngstown OH 44504-1315
Phone: (330) 884-1000
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 50-000351 Ohio
Emergency Medical Service Providers / Personal Emergency Response Attendant 146D00000X 50000351 Ohio

Profile Details

NPI number 1912928441
LBN Legal business name Jackson, Larry D
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 21st, 2006
Last updated Nov 20th, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912928441 NPPES
Ohio Other 970029949 MEDICARE TRAVELERS RR-GA

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