IndividualActive
Randy Jackson, PA-C
NPI 1508825357 · Physician Assistant · Millinocket, ME
Provider details
- NPI number
- 1508825357
- Entity type
- Individual
- Primary specialty
- Physician AssistantPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- License
- PA-028 (ME)
Practice location
200 Somerset St
Suite 2
Millinocket, ME 04462-1258
Phone: (207) 723-5173
Fax: (207) 723-3040
Mailing address
200 Somerset St
Millinocket, ME 04462-1258
Registry dates
- Enumerated
- 2006-03-21
- Last updated
- 2013-02-11
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.