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

Kyle Robert Jackson, PA

Individual provider Physician Assistant · NPI 1104007301

Kyle Robert Jackson, PA is a Physician Assistant in Pittsburgh, Pennsylvania. Qualified in 2007, 19 years ago. Practices with Allegheny Clinic, a 2,300-clinician group and accepts Medicare assignment. Licensed in Pennsylvania.

Years since qualifying
19
Licensed in
PA
In the registry since
2007
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

1307 Federal St Ste 2
Pittsburgh, PA 15212-4769
Phone: (877) 660-6777
Fax: (441) 359-8055
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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 MA053099 (PA)

Record details

NPI number1104007301
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedNovember 16, 2007
Last updated in NPPESOctober 12, 2020
Certification dateOctober 12, 2020

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2007 (19 years in practice)
Group practice Allegheny Clinic — 2300 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations7 on file with Medicare

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