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

Jennifer J Lackman, PA

Individual provider Physician Assistant · NPI 1184015414

Jennifer J Lackman, PA is a Physician Assistant in Grand Rapids, Michigan. Graduated from Emory University School of Medicine in 2014, 12 years ago. Practices with Advantage Health/Saint Mary's Medical Group, a 494-clinician group and accepts Medicare assignment. Licensed in California and Michigan.

Years since qualifying
12
Trained at
Emory University School of Medicine
Licensed in
CA, MI
In the registry since
2015
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

310 Lafayette Ave SE
Grand Rapids, MI 49503-4693
Phone: (616) 685-8200
Fax: (616) 685-8202
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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 PA55661 (CA)
Physician Assistant Taxonomy 363A00000X · Licence 5601007301 (MI)

Record details

NPI number1184015414
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedFebruary 9, 2015
Last updated in NPPESApril 6, 2022
Certification dateApril 6, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolEMORY UNIVERSITY SCHOOL OF MEDICINE
Graduated 2014 (12 years in practice)
Group practice Advantage Health/Saint Mary'S Medical Group — 494 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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