MR. LARRY RANDOLPH JACKSON (NPI# 1093878191) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093878191 |
| Entity Type | Individual |
| Full Name | MR. LARRY RANDOLPH JACKSON |
| Other Name | MR. LARRY RANDOLPH JACKSON |
| Credential | REGISTERED NURSE |
| Practice Address |
615 Rapids Rd Columbia SC 29212-3024 |
| Practice Telephone | 8037982211 |
| Mailing Telephone | 8037982211 |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 163WP0808X |
Registered Nurse Specialization: Psych/Mental Health |
56879 | SC | Nursing Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568855724 | Larry Jackson Jr. | Specialist/Technologist | 826 Warfield Pl, Lexington, KY 40505-3612 | 2015-03-12 |
| 1396186276 | Larry Tyler Jackson | Dentist | 14100 N 83rd Ave, Ste 280, Peoria, AZ 85381-5658 | 2013-07-08 |
| 1710068499 | Larry M. Jackson | Nutritionist | 9357 S Kingston Ave, Chicago, IL 60617-4042 | 2006-10-18 |
| 1093169062 | Larry Jackson Jr. | Counselor | 1420 Central Ave, Dubuque, IA 52001-4842 | 2016-04-15 |
| 1679971667 | Larry Jackson | Specialist | 1501 5th Ave N, St Petersburg, FL 33705-2008 | 2014-12-08 |
| 1578880548 | Larry Arthur Jackson | Family Medicine | 1445 Gateway Blvd, Cottage Grove, OR 97424-1224 | 2010-04-29 |
| 1023285582 | Larry Ronald Jackson II | Internal Medicine | 2301 Erwin Rd, Durham, NC 27710-0001 | 2008-05-14 |
| 1912928441 | Larry D Jackson | Personal Emergency Response Attendant | 500 Gypsy Ln, Youngstown, OH 44504-1315 | 2006-07-21 |
| 1275574295 | Larry K Jackson | Internal Medicine | 2660 10th Ave S, Suite 528, Birmingham, AL 35205-1605 | 2006-06-09 |
| 1720049349 | Larry Jackson | Family Medicine | 6565 W Main St, Kalamazoo, MI 49009-6114 | 2006-03-31 |
| Street Address |
615 RAPIDS RD |
| City | COLUMBIA |
| State | SC |
| Zip Code | 29212-3024 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245758887 | Amanda Gail Holloman | Pharmacist | 6021 St. Andrews Road, Columbia, SC 29212 | 2017-09-04 |
| 1578080180 | Alvin Mitchell Jr. | Non-emergency Medical Transport (VAN) | 10 Breezewood Court, Columbia, SC 29212 | 2017-08-24 |
| 1467975102 | Shelby Clemmer | Behavior Technician | 2 Harbison Way, Columbia, SC 29212 | 2017-07-25 |
| 1982149019 | Showntellem | Private Vehicle | 336 Foxfire Dr, Columbia, SC 29212 | 2016-12-28 |
| 1902215296 | Miranda Willis Adult Day Care, LLC | Social Worker | 5932 Mcmillian Circle, Columbia, SC 29212 | 2014-08-12 |
| 1013342591 | Robert Glendon Long | Pediatrics | 15 Woodpine Ct, Columbia, SC 29212 | 2013-09-04 |
| 1174969638 | Melinda Dumas Crenshaw | Psychologist | 2800 Ashland Rd., Columbia, SC 29212 | 2013-05-10 |
| 1417209982 | Physician Services LLC | Internal Medicine | 214 Lake Front Drive, Physician Services, Cola, SC 29212 | 2012-10-09 |
| 1306131800 | Rocky Mountain Holdings LLC | Ambulance | 6015 Saint Andrews Rd, Columbia, SC 29212 | 2011-06-13 |
| 1023262839 | Candace Anne Aguiar | Nurse Anesthetist, Certified Registered | 400 Palmetto Health Pkwy, Palmetto Health Baptist Parkridge, Columbia, SC 29212 | 2008-11-06 |
| Find all providers in zip 29212 | ||||
| Taxonomy Code | 163WP0808X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578185369 | Marion Johnson | Registered Nurse | 9633 Clocktower Ln, Columbia, MD 21046-1877 | 2020-05-14 |
| 1073167185 | Shyeasha Wilson | Registered Nurse | 1460 Oakcrest Dr Apt 2120, Columbia, SC 29223-1746 | 2019-07-26 |
| 1689122640 | Chanelle M Johnson | Registered Nurse | 217 Gateway Ln, Columbia, SC 29210-7452 | 2016-09-19 |
| 1871980763 | Bertha Ansley | Registered Nurse | 10775 Bridlerein Ter, Columbia, MD 21044-3650 | 2015-04-19 |
| 1356631022 | Henretta Nesbitt Milton | Registered Nurse | 105 Saddleridge Rd, Columbia, SC 29223-4245 | 2011-04-14 |
| 1427378157 | Nekesha Lashae Archie | Registered Nurse | 2020 Hampton St, 3rd Floor, Columbia, SC 29204-1002 | 2010-06-04 |
| 1750575338 | Fredrick J. Astle | Registered Nurse | 2638 Two Notch Road, Suite 110, Columbia, SC 29204 | 2007-08-28 |
| 1942330014 | Jason Matthew Tallman | Registered Nurse | 109 Kensington Pl, Columbia, TN 38401-8885 | 2007-03-06 |
| 1477629582 | Nancy Ragan Canaday | Registered Nurse | 2715 Colonial Drive, Columbia, SC 29203 | 2006-11-28 |
| 1720037872 | Priscilla L. Addison | Registered Nurse | 2715 Colonial Dr, Camhc, Columbia, SC 29203-6818 | 2006-05-08 |
| Find all providers in COLUMBIA | ||||
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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.