{"npi":"1104283365","type":"NPI-1","status":"active","name":{"display":"Kaylyn Jackson PA","other":[{"code":"1","type":"Formerly known as","value":"PRICE, KAYLYN"}],"first":"KAYLYN","last":"JACKSON","middle":"A","credential":"PA"},"specialty":{"primary_taxonomy":"363A00000X","primary_taxonomy_description":"Physician Assistant","slug":"physician-assistant","schema_org_specialty":null,"all":[{"code":"363A00000X","description":"Physician Assistant","primary":false,"state":"MI","license":"5601011711"},{"code":"363AS0400X","description":"Surgical Physician Assistant","primary":false,"state":"VA","license":"0110-005201"},{"code":"363A00000X","description":"Physician Assistant","primary":true,"state":"VA","license":"0110005201"}]},"addresses":[{"purpose":"LOCATION","street_1":"2001 CRYSTAL SPRING AVE SW STE 201","city":"ROANOKE","state":"VA","postal_code":"240142465","country_code":"US","phone":"5408530100"},{"purpose":"MAILING","street_1":"213 S JEFFERSON ST STE 1006","city":"ROANOKE","state":"VA","postal_code":"240111713","country_code":"US"}],"license":{"state":"VA","number":"0110005201"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"1104283365","state":"VA","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"I20160422002048","type_code":"14-97","type_desc":"PRACTITIONER - PHYSICIAN ASSISTANT","state":"VA","pac_id":"9739488818"}]},"enumeration_date":"2016-01-19","last_updated":"2025-08-15","_meta":{"source":"NPPES","snapshot_date":"2025-08-15","doc_url":"https://findmynpi.com/api"}}