MRS. KELLY JACKSON (NPI# 1033653431) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033653431 |
| Entity Type | Individual |
| Full Name | MRS. KELLY JACKSON |
| Credential | RN, FNP-C |
| Practice Address |
606 W Columbia St San Augustine TX 75972-1709 |
| Mailing Address |
109 Woodruff Ln San Augustine TX 75972-2637 |
| Practice Telephone | 9362752940 |
| Practice Fax Number | 9362752954 |
| Enumeration Date | 2016-12-05 |
| Last Update Date | 2016-12-05 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
AP132765 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588036263 | Kelly Jackson | Social Worker | 2937 Ne 16th Ter, Gainesville, FL 32609-3234 | 2015-10-21 |
| 1477896876 | Kelly A Jackson | Occupational Therapist | 178 Manila Ave, Staten Island, NY 10306-5608 | 2013-04-03 |
| 1104986793 | Kelly A Jackson | Chiropractor | 190 North Main Street, Natick, MA 01760 | 2006-12-12 |
| 1518982487 | Kelly Donald Jackson | Dentist | 3023 Eastland Blvd Ste 112, Clearwater, FL 33761-4106 | 2006-07-13 |
| 1689273310 | Kelly Jackson | Behavior Technician | 27777 Inkster Rd Ste 100, Farmington Hills, MI 48334-5312 | 2020-10-23 |
| 1629544655 | Kelly Colleen Jackson | Counselor | 811 Madison St, Everett, WA 98203-4543 | 2018-10-17 |
| 1619457926 | Kelly Jackson | Physician Assistant | 12300 Mccracken Rd, Garfield Heights, OH 44125-2975 | 2018-08-16 |
| 1760961833 | Kelly D Jackson | Licensed Practical Nurse | 602 W Semands St, Conroe, TX 77301-1867 | 2018-08-09 |
| 1841780178 | Kelly Amanda Jackson | Nurse Practitioner | 1700 Medical Center Pkwy, Murfreesboro, TN 37129-2245 | 2018-05-11 |
| 1497108310 | Kelly Jackson | Massage Therapist | 1325 San Marco Blvd, Suite 102, Jacksonville, FL 32207-8568 | 2016-07-15 |
| Street Address |
606 W COLUMBIA ST |
| City | SAN AUGUSTINE |
| State | TX |
| Zip Code | 75972-1709 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366730244 | Christina Watson | Nurse Practitioner | 606 W Columbia St, San Augustine, TX 75972-1709 | 2011-07-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861619801 | Kim Marie Laird | Physical Therapy Assistant | Rt. 1 Box 725 Hwy 96 South, San Augustine, TX 75972 | 2007-04-19 |
| 1356465447 | D & H Enterprises | Assisted Living Facility | 1997 Davidson Drive, San Augustine, TX 75972 | 2007-03-16 |
| 1417052036 | Charles K Layton | Dentist | Rt 5 Box 723d, San Augustine, TX 75972 | 2006-09-14 |
| 1578547345 | Memorial Medical Center- San Augustine | General Acute Care Hospital | 511 Hospital St, San Augustine, TX 75972 | 2005-12-05 |
| 1548363526 | Memorial Medical Center-san Augustine | General Acute Care Hospital | 511 Hospital St, San Augustine, TX 75972 | 2006-09-06 |
| 1609953744 | Mathews Rental Inc | Durable Medical Equipment & Medical Supplies | 112 W Columbia Street, San Augustine, TX 75972-0207 | 2006-11-01 |
| 1033774906 | Kaneitra Nicole Garrett | Licensed Vocational Nurse | 924 Oliver St, San Augustine, TX 75972-1042 | 2019-05-07 |
| 1366842478 | Rebecca Hubbard | Specialist/Technologist | 805 N Milam St, A, San Augustine, TX 75972-1413 | 2014-08-26 |
| 1962496836 | Liberty County Hospital District No. 1 | Skilled Nursing Facility | 1203 Fm 1277, San Augustine, TX 75972-1635 | 2005-09-07 |
| 1295215010 | Curtis Leon Pillow Jr. | Physical Therapy Assistant | 1203 Fm 1277, San Augustine, TX 75972-1635 | 2018-08-21 |
| Find all providers in zip 75972 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053837955 | Chivas Paul Guillote | Nurse Practitioner | 511 Hospital Street, Emergency Department, San Augustine, TX 75972-2121 | 2017-08-22 |
| 1366730244 | Christina Watson | Nurse Practitioner | 606 W Columbia St, San Augustine, TX 75972-1709 | 2011-07-13 |
| 1336129865 | Sharon Kay Oglesbee | Nurse Practitioner | 504 E Hospital St, San Augustine, TX 75972-2122 | 2006-01-19 |
| 1366485450 | Billie J. Napier | Nurse Practitioner | 200 E Livingston St, San Augustine, TX 75972-2028 | 2006-06-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487255162 | Shaida Rahmatinick | Nurse Practitioner | 1515 W 22nd St, Houston, TX 77008-1501 | 2020-11-08 |
| 1891396586 | Stacey Lynne Ready | Nurse Practitioner | 200 Uptmore Rd, West, TX 76691-2339 | 2020-11-08 |
| 1992306609 | Jillian Mcclintock | Nurse Practitioner | 2506 Graystone Ln, Corinth, TX 76210-1607 | 2020-11-08 |
| 1851992515 | Stacie A Gregg | Nurse Practitioner | 1229 Johnny Ln, San Angelo, TX 76905-2331 | 2020-11-07 |
| 1285235929 | Activate Family Health, Pllc | Nurse Practitioner | 203 E Davis St Ste F-1026, Conroe, TX 77301-3159 | 2020-11-07 |
| 1629679782 | Kristen Aili Johnson | Nurse Practitioner | 3850 Fm 18, Abilene, TX 79602-2004 | 2020-11-05 |
| 1376144303 | Stephanie Renee Knight | Nurse Practitioner | 4326 Egret Dr, Seabrook, TX 77586-2557 | 2020-11-05 |
| 1457952319 | Olufunke Oyindamola Oshoba | Nurse Practitioner | 200 Odyssey Ln, Mansfield, TX 76063-3438 | 2020-11-05 |
| 1518568419 | Ian Mardis | Nurse Practitioner | 12528 Tierra Encino Dr, El Paso, TX 79938-4525 | 2020-11-05 |
| 1851992994 | Angela Davis | Nurse Practitioner | 9523 Scanlan Heights Ln, Missouri City, TX 77459-5503 | 2020-11-05 |
| Find all providers with the same taxonomy | ||||
| City | SAN AUGUSTINE |
| Zip Code | 75972 |
Please comment or provide details below to improve the information on MRS. KELLY JACKSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.