Carly A. Jackson, PA-C
Physician Assistant · Rockford, IL
UnclaimedPA-CNPI 1053696971
- Primary taxonomy
- 363A00000X
- Enumerated
- 2011-10-12
- Practice location
- Rockford, IL
- Last NPPES update
- 2014-06-05
State licenses
- IL · Physician assistant · LICENSED PHYSICIAN ASSISTANTExpiredthrough 2020
“Listed on NPI record” means the provider reported this license to NPPES; other statuses come from the state board’s public records as of the last import. License numbers are not shown.
Source: CMS National Plan & Provider Enumeration System (NPPES) and state licensing boards. ScrubHub shows name, credential, taxonomy, practice city/state and license status only.