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

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.

See every abbreviation used in this directory →

Practice location Address checks out

1906 Belleview Ave SE
Roanoke, VA 24014-1838
Phone: (540) 981-7000
Show map & directions

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

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