BRIAN JEFFRY JACKSON (NPI# 1174080030) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174080030 |
| Entity Type | Individual |
| Full Name | BRIAN JEFFRY JACKSON |
| Credential | NP |
| Practice Address |
2075 San Joaquin Hills Rd Newport Beach CA 92660-6505 |
| Mailing Address |
3801 Marquette Pl Apt 4c San Diego CA 92106-1059 |
| Practice Telephone | 9497609222 |
| Mailing Telephone | 5415506572 |
| Enumeration Date | 2019-02-27 |
| Last Update Date | 2019-10-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
NP95010531 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3801 Marquette Pl Apt 4c, San Diego, CA 921061059 | 5415506572 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083198659 | Brian John Jackson | Physician Assistant | 391 Lee Blvd Ste 300, Lehigh Acres, FL 33936-4973 | 2018-09-19 |
| 1316482425 | Brian Keith Jackson | Community Health Worker | 3714 Ruffin Rd, North Prince George, VA 23860-8629 | 2016-12-28 |
| 1346610011 | Brian Jackson | Counselor | 3008 Conmar St, Shreveport, LA 71108 | 2015-10-06 |
| 1255421855 | Brian R Jackson | Pathology | 500 E Chipeta Way, Salt Lake City, UT 84108-1221 | 2006-10-13 |
| 1467497461 | Brian D Jackson | Allergy & Immunology | 151 Harmony Park Circle, Hot Springs, AR 71913 | 2006-06-17 |
| 1689665408 | Brian E Jackson | Dentist | 2775 Bishop Rd, Suite C, Willoughby Hills, OH 44092-2683 | 2005-11-01 |
| 1306842356 | Brian D Jackson | Podiatrist | 1215 Hatcher Ln, Columbia, TN 38401-3531 | 2005-06-23 |
| 1477150738 | Brian Leslie Jackson | Registered Nurse | 2751 Napa Valley Corporate Dr Bldg B, Napa, CA 94558-6216 | 2020-10-08 |
| 1558973115 | Brian Lee Jackson | Pharmacist | 5780 Terry Rd, Byram, MS 39272-9745 | 2020-08-17 |
| 1457850067 | Brian Skeene Jackson | Recreation Therapist | 75 New Scotland Ave, Albany, NY 12208-3409 | 2018-02-09 |
| Street Address |
2075 SAN JOAQUIN HILLS RD |
| City | NEWPORT BEACH |
| State | CA |
| Zip Code | 92660-6505 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821043357 | Newport Walk In Medical Group, Inc. | Clinic/Center | 2075 San Joaquin Hills Rd, Newport Beach, CA 92660-6505 | 2006-05-23 |
| 1245705086 | Ryan Duy Pham | Physician Assistant | 2075 San Joaquin Hills Rd, Newport Beach, CA 92660-6505 | 2018-10-08 |
| 1811470925 | Courtney Galle | Nurse Practitioner | 2075 San Joaquin Hills Rd, Newport Beach, CA 92660-6505 | 2018-09-13 |
| 1568951440 | Luz Daniela Acevedo | Physician Assistant | 2075 San Joaquin Hills Rd, Newport Beach, CA 92660 | 2018-05-06 |
| 1235634940 | Philip Fagan IIi | General Practice | 2075 San Joaquin Hills Rd, Newport Beach, CA 92660-6505 | 2018-03-26 |
| 1669725271 | Erin Elizabeth Wood | Physician Assistant | 2075 San Joaquin Hills Rd, Newport Beach, CA 92660 | 2012-10-19 |
| 1538466107 | Marque Medical Clinic, Inc. | Family Medicine | 2075 San Joaquin Hills Rd, Newport Beach, CA 92660-6505 | 2011-02-17 |
| 1235265844 | Nathan Aron Kiskila | Family Medicine | 2075 San Joaquin Hills Rd, Newport Beach, CA 92660-6505 | 2007-02-26 |
| 1700911484 | Alison Sims M.d., Inc. | Clinic/Center | 2075 San Joaquin Hills Rd, Newport Beach, CA 92660-6505 | 2007-02-22 |
| 1407981285 | Alison F Sims | Internal Medicine | 2075 San Joaquin Hills Rd, Newport Beach, CA 92660-6505 | 2007-02-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275144024 | Lumins Aesthetic and Wellness, Inc | Dermatology | 20281 Sw Birch St, Suite 201, Newport Beach, CA 92660 | 2020-08-14 |
| 1205445798 | Felecia A Pedrogo | Marriage & Family Therapist | 5020 Campus Street, Newport Beach, CA 92660 | 2020-07-30 |
| 1649898388 | Polyviou Dental Corportation, Inc. | Clinic/Center | 120 Newport Beach Drive, Suite 27, Newport Beach, CA 92660 | 2020-07-09 |
| 1154974525 | Jan M. Eckermann, Md Inc. | Neurological Surgery | 1617 W Cliff Dr, Ste 203, Newport Beach, CA 92660 | 2019-07-24 |
| 1235792219 | Horizon Dermatology and Laser Institute | Dermatology | 369 San Miguel Dr. Suite 200, Newport Beach, CA 92660 | 2019-04-16 |
| 1902366925 | Yasmine Central Gohar | Marriage & Family Therapist | 20271 Sw Birch St Ste 200, Newport Beach, CA 92660 | 2019-03-25 |
| 1245703255 | Charison Counseling | Counselor | 4000 Macarthur Bvd Suite 600 East Tower, Newport Beach, CA 92660 | 2019-01-03 |
| 1134698996 | Amber Werner | Chiropractor | 4029 Westerly Place, Suite #115, Newport Beach, CA 92660 | 2018-11-21 |
| 1861969008 | Healthy Me Oc | Dietitian, Registered | 4569 Macarthur Court, Suite 1100, Newport Beach, CA 92660 | 2018-10-25 |
| 1174015192 | Edwin Enwia | Clinic/Center | 1000 Bristol St N Ste 1b, Newport Beach, CA 92660 | 2018-06-05 |
| Find all providers in zip 92660 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770077729 | Rachael L Duran | Nurse Practitioner | 320 Superior Ave Ste 230, Newport Beach, CA 92663-2779 | 2018-06-21 |
| 1891289088 | Joanna Juntila | Nurse Practitioner | 1 Hoag Dr Bldg 47, Newport Beach, CA 92663-4162 | 2018-06-20 |
| 1174079115 | Kristine Ericksen-miller | Nurse Practitioner | 4321 Birch St Ste 100, Newport Beach, CA 92660-1940 | 2016-08-30 |
| 1508236100 | Anisa Munshi | Nurse Practitioner | 20072 Sw Birch St Ste 230, Newport Beach, CA 92660-1506 | 2015-09-25 |
| 1710376587 | Kimberly Slawson | Nurse Practitioner | 1922 Baypointe Dr, Newport Beach, CA 92660-8526 | 2015-01-16 |
| 1225317985 | Sally T Barbella | Nurse Practitioner | 3110 Park Newport Apt 410, Newport Beach, CA 92660-5847 | 2011-08-12 |
| 1598053381 | Kimberly Anne De Jong | Nurse Practitioner | 500 Superior Ave Ste 160, Newport Beach, CA 92663-3677 | 2011-07-14 |
| 1447861984 | Janica Schmuck | Nurse Practitioner | 520 Superior Ave Ste 255, Newport Beach, CA 92663-3668 | 2020-08-10 |
| 1558984120 | Katherine Cosca Roy | Nurse Practitioner | 460 Old Newport Blvd, Newport Beach, CA 92663-4211 | 2020-05-18 |
| 1932749538 | Stayler Mcomie | Nurse Practitioner | 520 Superior Ave Ste 255, Newport Beach, CA 92663-3668 | 2020-01-10 |
| Find all providers in NEWPORT BEACH | ||||
| City | NEWPORT BEACH |
| Zip Code | 92660 |
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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.