DR. WILLIE MAE JACKSON (NPI# 1073754065) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073754065 |
| Entity Type | Individual |
| Full Name | DR. WILLIE MAE JACKSON |
| Credential | M.D. |
| Practice Address |
2211 Mayfair Dr Suite 409 Owensboro KY 42301-4568 |
| Mailing Address |
Po Box 23229 Owensboro KY 42304-3229 |
| Practice Telephone | 2704177980 |
| Practice Fax Number | 2704177989 |
| Mailing Telephone | 2704177980 |
| Mailing Fax Number | 2704177989 |
| Enumeration Date | 2009-03-20 |
| Last Update Date | 2020-11-04 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
46400 | KY | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 7100137210 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 601 W 2nd St, Bloomington, IN 474032317 | 8123533450 | 8123533451 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841571478 | Willie Pearl Jackson | Behavioral Analyst | 5304 Roseland Ave, Las Vegas, NV 89130-2635 | 2011-09-09 |
| 1013143395 | Willie Lee Jackson Jr. | Counselor | 157 Santa Barbara Plz, Los Angeles, CA 90008-2508 | 2009-06-01 |
| 1477687598 | Willie Jackson | Social Worker | 660 Park St, Jacksonville, FL 32204-2933 | 2007-03-14 |
| 1447349436 | Willie D Jackson | Counselor | 11301 Wilshire Blvd, Bldg 206 Room 24, Los Angeles, CA 90073-1003 | 2006-10-11 |
| 1043312960 | Willie Mae Jackson | Dietetic Technician, Registered | 820 S Damen Ave, Chicago, IL 60612-3728 | 2006-09-01 |
| Street Address |
2211 MAYFAIR DR SUITE 409 |
| City | OWENSBORO |
| State | KY |
| Zip Code | 42301-4568 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770589970 | Elizabeth Hawkins Ottman | Obstetrics & Gynecology | 2211 Mayfair Dr, Ste 301, Owensboro, KY 42301-4569 | 2005-06-22 |
| 1518326990 | Owensboro Health Medical Group, Inc. | Nurse Practitioner | 2211 Mayfair Dr, Suite 305, Owensboro, KY 42301-4568 | 2016-02-15 |
| 1669863585 | Whitney Dawn Peay | Counselor | 2211 Mayfair Dr, Suite 409, Owensboro, KY 42301-4568 | 2015-02-13 |
| 1558779009 | Owensboro Health Medical Group, Inc | Plastic Surgery | 2211 Mayfair Dr, Suite 305, Owensboro, KY 42301-4568 | 2014-07-29 |
| 1932530029 | Stephanie M Decker | Social Worker | 2211 Mayfair Dr, Ste 409, Owensboro, KY 42301-4570 | 2013-11-27 |
| 1639517451 | Snehamala Veeravalli | Psychiatry & Neurology | 2211 Mayfair Dr, Suite 409, Owensboro, KY 42301-4568 | 2013-06-14 |
| 1013353101 | Owensboro Health Medical Group, Inc | Counselor | 2211 Mayfair Dr, Suite 409, Owensboro, KY 42301 | 2013-05-15 |
| 1669739777 | Jin S. Amon | Psychiatry & Neurology | 2211 Mayfair Dr, Suite 409, Owensboro, KY 42301-4568 | 2012-04-13 |
| 1699067074 | Associated Owensboro Urology | Urology | 2211 Mayfair Dr, Suite 401, Owensboro, KY 42301-4568 | 2011-05-04 |
| 1518258177 | Ohio County Hospital Corp Inc | Urology | 2211 Mayfair Dr, Suite 410, Owensboro, KY 42301-4568 | 2011-04-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124558002 | To The Max Behavior Therapy, LLC | Behavioral Analyst | 905 Griffith Avenue, Owensboro, KY 42301 | 2017-06-14 |
| 1558747014 | Kendall L Tapp | Counselor | 1925 Frederica St, Owensboro, KY 42301 | 2015-08-07 |
| 1104168210 | Behavior Associates, LLC | Psychologist | 3445 Wathens Xing Ste 104, Owensboro, KY 42301 | 2013-03-27 |
| 1285990259 | Jaime E Ford | Preventive Medicine | 1723 Windsor Ave., Owensboro, KY 42301 | 2012-04-04 |
| 1457637043 | Bliss United Dental Services Dba Owensboro Family Dentistry | Dentist | 4921 Goetz Dr., Owensboro, KY 42301 | 2011-10-26 |
| 1932483138 | Dennis Craig Hodges | Pharmacist | 2318 Frederica Street, Owensboro, KY 42301 | 2011-10-06 |
| 1225317381 | Donna Kay Ewing | Social Worker | 1925 Frederica St Ste 200, Owensboro, KY 42301 | 2011-08-08 |
| 1639489230 | Easycare Inc | Durable Medical Equipment & Medical Supplies | 5010 Back Square Drive, Owensboro, KY 42301 | 2010-10-15 |
| 1962727529 | Amy Martin | Physical Therapy Assistant | 2420 West Thrid Street, Owensboro, KY 42301 | 2010-04-07 |
| 1215163837 | Green River District Health Department | Public Health or Welfare | 5390 Hwy 56, Owensboro, KY 42301 | 2009-06-10 |
| Find all providers in zip 42301 | ||||
| Taxonomy Code | 2084P0800X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Psychiatry |
| A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972902526 | S. Montgomery Md & Associates Behavioral Healthcare | Psychiatry & Neurology | 620 Carlton Drive, Suite 101, Owensboro, KY 42303 | 2014-08-20 |
| 1023099975 | Debra Lynne Bunger | Psychiatry & Neurology | 1201 Pleasant Valley Rd, Owensboro, KY 42303-9811 | 2005-11-08 |
| 1356874200 | Raven R. Price | Psychiatry & Neurology | 2211 Mayfair Dr Ste 409, Owensboro, KY 42301-4570 | 2017-04-07 |
| 1336594563 | Naren T. Vellanki | Psychiatry & Neurology | 1201 Pleasant Valley Rd, Owensboro, KY 42303 | 2016-04-25 |
| 1205290319 | Jeramie Lynn Rosales Rodriguez | Psychiatry & Neurology | 1201 Pleasant Valley Rd, Owensboro, KY 42303 | 2016-04-06 |
| 1073909099 | Erik Rotterman | Psychiatry & Neurology | 1100 Walnut St, Owensboro, KY 42301-2956 | 2015-04-07 |
| 1639517451 | Snehamala Veeravalli | Psychiatry & Neurology | 2211 Mayfair Dr, Suite 409, Owensboro, KY 42301-4568 | 2013-06-14 |
| 1669739777 | Jin S. Amon | Psychiatry & Neurology | 2211 Mayfair Dr, Suite 409, Owensboro, KY 42301-4568 | 2012-04-13 |
| 1700161056 | Acumen Counseling Services, Inc. | Psychiatry & Neurology | 1100 Walnut St, Owensboro, KY 42301-2956 | 2011-10-19 |
| 1902134711 | Brio Psychiatry Associates, Pllc | Psychiatry & Neurology | 1102 Triplett St, Suite 2100, Owensboro, KY 42303-3104 | 2009-12-07 |
| Find all providers in OWENSBORO | ||||
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| 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.