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

Travis Wiley Jackson, MD

Individual provider Dermatology Physician · NPI 1093657439

Travis Wiley Jackson, MD is a Dermatology Physician in Saint Louis, Missouri. Practices as a sole proprietor. Licensed in Missouri.

Licensed in
MO
In the registry since
2026
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

See every abbreviation used in this directory →

Practice location Address checks out

621 S New Ballas Rd Ste 3019B
Saint Louis, MO 63141-8267
Phone: (314) 509-5305
Fax: (314) 251-4454
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X · Licence 2026021643 (MO)

Record details

NPI number1093657439
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedApril 6, 2026
Last updated in NPPESMay 27, 2026
Certification dateMay 27, 2026

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