Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Derrell Glenn Jackson, PA-C

Individual provider Medical Physician Assistant · NPI 1104072297

Derrell Glenn Jackson, PA-C is a Medical Physician Assistant in Colonial Heights, Virginia. Licensed in Virginia. Registered with an NPI since 2008.

Licensed in
VA
In the registry since
2008
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

436 Claremont Ct Ste 100
Colonial Heights, VA 23834-1765
Phone: (804) 526-2121
Fax: (804) 520-2617
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 0110002804 (VA)
Medical Physician Assistant Taxonomy 363AM0700X · Licence 0110002804 (VA)

Record details

NPI number1104072297
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedAugust 8, 2008
Last updated in NPPESMay 26, 2010
Mailing address205 Misty Ridge Ln, Suffolk, VA 23434-1516

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