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

Mr. Samuel Robert Jackson, PA

Individual provider Physician Assistant · NPI 1699274993

Mr. Samuel Robert Jackson, PA is a Physician Assistant in Roanoke, Virginia. Licensed in Virginia. Registered with an NPI since 2018.

Licensed in
VA
In the registry since
2018
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

1906 Belleview Ave SE
Roanoke, VA 24014-1838
Phone: (540) 981-7000
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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 0110006058 (VA)

Record details

NPI number1699274993
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedFebruary 2, 2018
Last updated in NPPESFebruary 2, 2018
Mailing address719 Arbutus Ave Se, Roanoke, VA 24014-2503

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