UNDRA JACKSON (NPI# 1083196851) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083196851 |
| Entity Type | Individual |
| Full Name | UNDRA JACKSON |
| Practice Address |
1701 White St Mccomb MS 39648-2711 |
| Practice Telephone | 6012494218 |
| Practice Fax Number | 6012494234 |
| Mailing Telephone | 6012494218 |
| Mailing Fax Number | 6012494234 |
| Enumeration Date | 2018-08-29 |
| Last Update Date | 2018-08-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YS0200X |
Counselor Specialization: School |
Behavioral Health & Social Service Providers |
| Street Address |
1701 WHITE ST |
| City | MCCOMB |
| State | MS |
| Zip Code | 39648-2711 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932159423 | Jody Mcintyre | Marriage & Family Therapist | 1701 White St, Mccomb, MS 39648-2711 | 2006-05-12 |
| 1376144519 | Tameka Pinder | Registered Nurse | 1701 White St, Mccomb, MS 39648-2711 | 2020-11-04 |
| 1225637002 | Ariel Coleman | Counselor | 1701 White St, Mccomb, MS 39648-2711 | 2020-10-22 |
| 1821695313 | Sherrie Short | Counselor | 1701 White St, Mccomb, MS 39648-2711 | 2020-10-07 |
| 1013524396 | Catina Brigss | Counselor | 1701 White St, Mccomb, MS 39648-2711 | 2020-09-30 |
| 1114533288 | Lasontiga Forrest | Registered Nurse | 1701 White St, Mccomb, MS 39648-2711 | 2020-09-23 |
| 1831707439 | Vanessa L Gardner | Counselor | 1701 White St, Mccomb, MS 39648-2711 | 2020-07-20 |
| 1366069080 | Ramonda Copeland | Counselor | 1701 White St, Mccomb, MS 39648-2711 | 2020-06-29 |
| 1154947018 | Kimberly Hurst | Counselor | 1701 White St, Mccomb, MS 39648-2711 | 2020-06-17 |
| 1770104598 | Hanna Moak | Counselor | 1701 White St, Mccomb, MS 39648-2711 | 2020-05-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952910366 | Ct Stamps Inc | Pharmacy | 206 Marion Avenue, Mccomb, MS 39648 | 2020-07-31 |
| 1952910457 | Fresenius Medical Care East Mccomb Dialysis, LLC | Clinic/Center | 103 Business Center Drive, Mccomb, MS 39648 | 2020-07-30 |
| 1902423312 | Joseph Edward Mingo II | Counselor | 513 Lee St, Mccomb, MS 39648 | 2020-07-01 |
| 1427608769 | Benda Truvillion | Technician | 2128 Park Dr. Ext., Mccomb, MS 39648 | 2019-09-18 |
| 1295228187 | Edna Ruth Winston | Counselor | Sw Ms Mental Health Complex, 1701 White St, Mccomb, MS 39648 | 2018-06-14 |
| 1386153450 | Sholitha Nunnery | Counselor | 502 North Cherry Street, Mccomb, MS 39648 | 2017-09-21 |
| 1548600612 | Jordan Harrington | Nurse Practitioner | 303 Marion Ave., Mccomb, MS 39648 | 2013-07-03 |
| 1891096236 | Zwound Care | Family Medicine | 1126 Country Club Road, Mccomb, MS 39648 | 2010-11-16 |
| 1588891717 | Kelly Edmondson | Physical Therapy Assistant | 1301a Harrison Ave, Mccomb, MS 39648 | 2009-06-15 |
| 1962647651 | Gwendolyn Michelle Brown | Home Health Aide | 1114 1/2 Venable St., Mccomb, MS 39648 | 2008-12-09 |
| Find all providers in zip 39648 | ||||
| Taxonomy Code | 101YS0200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | School |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053959874 | Leotyne Anderson | Counselor | 124 Major Cir, Saltillo, MS 38866-8109 | 2019-12-11 |
| 1649742933 | Karen Patricia Noone-yvon | Counselor | 711 N Union St, Natchez, MS 39120-2950 | 2018-12-26 |
| 1265724504 | Building Bridges Association | Counselor | 4925 Poplar Springs Dr, Meridian, MS 39305-1618 | 2011-05-04 |
| 1740881911 | Creations of Care Home Health Care Ll. | Counselor | 1520 29th Ave Ste 8, Gulfport, MS 39501-2843 | 2020-11-04 |
| 1578055489 | Gwendolyn Earlene Shaw | Counselor | 152 Highway 7 S, Oxford, MS 38655 | 2018-06-06 |
| 1134677008 | Bridget Charese Lesure | Counselor | 152 Highway 7 S, Oxford, MS 38655-5392 | 2016-09-20 |
| 1801341979 | Paul Dean Ross | Counselor | 152 Highway 7 S, Oxford, MS 38655-5392 | 2016-08-18 |
| 1063816981 | Raneshia N Lee | Counselor | 2725 Highway 51 S, Hernando, MS 38632-2634 | 2014-10-21 |
| 1053733261 | Kimberly Jean Stevenson | Counselor | 152 Highway 7 S, Oxford, MS 38655-5392 | 2014-01-08 |
| 1316287360 | Constance N Powell | Counselor | 152 Highway 7 S, Oxford, MS 38655-5392 | 2013-02-27 |
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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.