MR. RODNEY DEWAYNE JACKSON (NPI# 1093965089) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093965089 |
| Entity Type | Individual |
| Full Name | MR. RODNEY DEWAYNE JACKSON |
| Other Name | MR. RODNEY DEWAYNE JACKSON |
| Credential | CTRS |
| Practice Address |
2200 Fort Roots Dr North Little Rock AR 72114-1709 |
| Practice Telephone | 5012573086 |
| Practice Fax Number | 5012573276 |
| Mailing Telephone | 5012573086 |
| Mailing Fax Number | 5012573276 |
| Enumeration Date | 2008-09-25 |
| Last Update Date | 2020-03-31 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 174400000X | Specialist | Other Service Providers | ||
| Y | 225800000X | Recreation Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063972669 | Rodney Lajuan Jackson Jr. | Behavior Technician | 7445 39th Pl N, St Petersburg, FL 33709-4310 | 2019-03-21 |
| 1205125747 | Rodney Jackson | Occupational Therapist | 18135 W Catawba Ave Ste 11, Cornelius, NC 28031-5641 | 2011-04-05 |
| 1306981295 | Rodney Jackson | Case Manager/Care Coordinator | 5849 Crocker St Unit L, Los Angeles, CA 90003-1311 | 2007-02-20 |
| 1205931599 | Rodney Allen Jackson | Dentist | 2517 Sir Barton Way Ste 200, Lexington, KY 40509-2275 | 2006-09-13 |
| 1285659615 | Rodney Gilkey Jackson | Chiropractor | 309 Laurel Ave, Tillamook, OR 97141-2313 | 2006-07-13 |
| 1457838062 | Rodney Jackson Jr. | Case Manager/Care Coordinator | 1800 Mercy Dr, Orlando, FL 32808-5646 | 2018-07-26 |
| 1538602941 | Rodney Jackson Sr. | Nurse's Aide | 4300 Sw 13th St, Gainesville, FL 32608-4006 | 2016-12-02 |
| 1619975398 | Rodney Mark Jackson | Specialist | 3654 W Anthem Way, Suite B-114, Anthem, AZ 85086-0455 | 2005-07-07 |
| Street Address |
2200 FORT ROOTS DR |
| City | NORTH LITTLE ROCK |
| State | AR |
| Zip Code | 72114-1709 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750388401 | Ivy V Mcgee | Family Medicine | 2200 Fort Roots Dr, North Little Rock, AR 72114-1709 | 2005-07-07 |
| 1477161586 | Kaila Mitchell | Psychologist | 2200 Fort Roots Dr, North Little Rock, AR 72114-1709 | 2020-07-15 |
| 1689200040 | Tonie Brenee' Williams | Social Worker | 2200 Fort Roots Dr, North Little Rock, AR 72114-1709 | 2020-03-18 |
| 1447899646 | Eugenia Boozer | Clinical Neuropsychologist | 2200 Fort Roots Dr, North Little Rock, AR 72114-1709 | 2020-01-06 |
| 1376181263 | Linda Shrader | Technician | 2200 Fort Roots Dr, North Little Rock, AR 72114 | 2019-12-11 |
| 1205470507 | Julie Renee Thyberg | Technician | 2200 Fort Roots Dr, North Little Rock, AR 72114-1709 | 2019-10-30 |
| 1588215966 | Venius Vernester Russell | Technician | 2200 Fort Roots Dr, North Little Rock, AR 72114-1709 | 2019-09-26 |
| 1538718119 | Mary Kathryn Martin | Technician | 2200 Fort Roots Dr, North Little Rock, AR 72114-1709 | 2019-09-06 |
| 1689223596 | Meriline White | Technician | 2200 Fort Roots Dr, North Little Rock, AR 72114-1709 | 2019-09-04 |
| 1124677943 | Felicia Clayton | Technician | 2200 Fort Roots Dr, North Little Rock, AR 72114 | 2019-09-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316432966 | Mid State Counseling and Recovery Service | Clinic/Center | 1920 Main St Ste 229, North Little Rock, AR 72114 | 2018-06-26 |
| 1053826842 | Kelli Lauron Johnson | Nurse Practitioner | 2800 North Willow Street, North Little Rock, AR 72114 | 2017-12-03 |
| 1689117756 | State of Arkansas | Skilled Nursing Facility | 2401 John Ashley Drive, Building #100, North Little Rock, AR 72114 | 2016-11-22 |
| 1366787459 | J Andrew Mccullough | Counselor | 628 W Broadway St Ste 300, North Little Rock, AR 72114 | 2012-11-30 |
| 1598071490 | Roger Elliott Hicks IIi | Counselor | 2200 Fort Roots Dr # 3d, North Little Rock, AR 72114 | 2010-08-30 |
| 1740594456 | Tuyet Thi Van | Dentist | 520 W. Pershing Blvd., North Little Rock, AR 72114 | 2010-08-05 |
| 1467764183 | Jennifer Leigh Nash | Behavioral Analyst | 628 W Broadway St Ste 100, North Little Rock, AR 72114 | 2010-07-10 |
| 1336398544 | Tina A Davie | Registered Nurse | 2200 Foot Roots Drive, Little Rock, AR 72114 | 2008-09-11 |
| 1316125313 | Centers for Youth & Families | Community/Behavioral Health | 200 W. 20th, North Little Rock, AR 72114 | 2008-02-01 |
| 1881878064 | Marie A Graham | Nurse Practitioner | 636 West Broadway St, No Little Rock, AR 72114 | 2007-12-24 |
| Find all providers in zip 72114 | ||||
| Taxonomy Code | 225800000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Recreation Therapist |
| A recreation therapist uses recreational activities for intervention in some physical, social or emotional behavior to bring about a desired change in that behavior and promote the growth and development of the patient. |
| Notes: Source: Joel A. DeLisa and Bruce M. Gans, Rehabilitation Medicine: Principles and Practice Second Edition, J.B. Lippincott Company, Philadelphia: 1993, p. 7 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740394113 | Robert William Hill | Recreation Therapist | 2200 Fort Roots Drive, 118/nlr, North Little Rock, AR 72114 | 2006-08-19 |
| 1588891246 | Jan J Bowman | Recreation Therapist | 2200 Fort Roots Dr, North Little Rock, AR 72114-1709 | 2009-06-19 |
| 1205060506 | Susan Leigh Bradley | Recreation Therapist | 2200 Fort Roots Drive, North Little Rock, AR 72114-1706 | 2009-05-14 |
| 1508001033 | Linda Diann Smith | Recreation Therapist | 2200 Fort Roots Dr, North Little Rock, AR 72114-1709 | 2008-12-12 |
| 1538313143 | Erica Kirkes | Recreation Therapist | 2200 Fort Roots Dr, North Little Rock, AR 72114-1709 | 2008-11-10 |
| 1033226923 | Mark A Douglas | Recreation Therapist | 2200 Fort Roots Dr, North Little Rock, AR 72114-1709 | 2006-08-24 |
| 1750304986 | Kathleen Joan Harris | Recreation Therapist | 2200 Fort Roots Dr, Building 170 2k 116, North Little Rock, AR 72114-1709 | 2006-07-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730380296 | Vickie Ladd | Recreation Therapist | 103 W Parkway Dr, Suite 'd', Russellville, AR 72801-3700 | 2007-05-30 |
| 1295941987 | Isaac Brett Hendrix | Recreation Therapist | 20400 Colonel Glenn Rd, Little Rock, AR 72210-5323 | 2007-05-16 |
| 1538376074 | John W Keisker | Recreation Therapist | 20400 Colonel Glenn Rd, Little Rock, AR 72210-5323 | 2007-05-16 |
| 1023223302 | Don Riley | Recreation Therapist | 20400 Colonel Glenn Rd, Little Rock, AR 72210-5323 | 2007-05-11 |
| 1265646046 | Gerren Frazier | Recreation Therapist | 20400 Colonel Glenn Rd, Little Rock, AR 72210-5323 | 2007-05-10 |
| 1710191416 | Lakesha R Meadows | Recreation Therapist | 20400 Colonel Glenn Rd, Little Rock, AR 72210-5323 | 2007-05-10 |
| 1871707190 | Shelly Ann Zellner | Recreation Therapist | 20400 Colonel Glenn Rd, Little Rock, AR 72210-5323 | 2007-05-09 |
| City | NORTH LITTLE ROCK |
| Zip Code | 72114 |
Please comment or provide details below to improve the information on MR. RODNEY DEWAYNE 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.