Type 1 · Individual ✓ Active NPI ✓ Valid NPI checksum

Derrell Glenn Jackson, PA-C

Physician Assistant in Colonial Heights, VA · enumerated 2008.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1104072297

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Registry record

Entity type Individual (Type 1)

Name Derrell Glenn Jackson

Credential PA-C

Sex Male

Practice address 436 Claremont Ct, Suite 100, Colonial Heights, VA, 23834

Phone (804) 526-2121

Fax (804) 520-2617

Enumeration date Aug 8, 2008

Last updated in NPPES May 26, 2010

Taxonomy & licenses

363AM0700X Medical Physician Assistant Physician Assistants & Advanced Practice Nursing Providers · License 0110002804 (VA) Secondary

363A00000X Physician Assistant Physician Assistants & Advanced Practice Nursing Providers · License 0110002804 (VA) Primary

Other identifiers

Identifier	Type	State	Issuer
1104072297	Medicaid	VA	-
10040880P	Other	VA	OPTIMA
P00685057	Other	VA	RR MEDICARE
10040880P	Other	VA	SENTARA HEALTHCARE

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

Read the full guide → Validate an NPI →

Frequently asked questions

Where does Derrell Jackson practice?

The practice location on file with NPPES is in Colonial Heights, VA. Providers can have multiple locations; NPPES lists the primary practice address.

What is the NPI number for Derrell Jackson?

The National Provider Identifier (NPI) for Derrell Jackson is 1104072297, a Type 1 (individual) record in the CMS NPPES registry.

Other providers at this practice address

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Clark Hunt Family Medicine Physician · Colonial Heights, VA NPI 1316937162 Petersburg Clinic Company, LLC Family Medicine Physician · Colonial Heights, VA NPI 1528022506 James Ross Internal Medicine Physician · Colonial Heights, VA NPI 1932157757 Petersburg Hospital Company LLC Community Health Clinic/Center · Colonial Heights, VA NPI 1902942071

Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2010-05-26.