DOMINIQUE TERENCE JACKSON (NPI# 1174081822) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174081822 |
| Entity Type | Individual |
| Full Name | DOMINIQUE TERENCE JACKSON |
| Credential | NURSE PRACTITIONER |
| Practice Address |
1791 Alum Creek Dr Ste 100 Columbus OH 43207 |
| Mailing Address |
2780 Airport Dr Ste 100 Columbus OH 43219-2289 |
| Practice Telephone | 6145265420 |
| Practice Fax Number | 6146455517 |
| Mailing Telephone | 6148591906 |
| Mailing Fax Number | 6146455517 |
| Enumeration Date | 2019-03-12 |
| Last Update Date | 2019-08-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
APRN.CNP.024669 | OH | Physician Assistants & Advanced Practice Nursing Providers |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1 N White Horse Pike, Hammonton, NJ 080371875 | 6095671169 | |
| 1301 Atlantic Ave, Atlantic City, NJ 084017247 | 6095720000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538629639 | Dominique Jackson | Social Worker | 1521 Gull Rd, Kalamazoo, MI 49048-1640 | 2019-03-23 |
| 1679000814 | Dominique Jackson | Nurse Practitioner | 2309 E 15th St, Panama City, FL 32405-6345 | 2017-05-18 |
| 1184164949 | Dominique Jackson | Student in an Organized Health Care Education/Training Program | 1738 S Tremont St, Oceanside, CA 92054-5309 | 2017-02-27 |
| Street Address |
1791 ALUM CREEK DR STE 100 |
| City | COLUMBUS |
| State | OH |
| Zip Code | 43207 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194071050 | Columbus Neighborhood Health Center, Inc. | Clinic/Center | 1791 Alum Creek Dr Ste 100, Columbus, OH 43207 | 2012-07-30 |
| 1982199675 | Clayton A Frederick | Registered Nurse | 1791 Alum Creek Dr Ste 100, Columbus, OH 43207-1708 | 2018-06-26 |
| 1215427679 | Grace Lucile Gotschall | Clinic/Center | 1791 Alum Creek Dr Ste 100, Columbus, OH 43207-1708 | 2018-05-11 |
| 1194213645 | Rachel Bishop | Social Worker | 1791 Alum Creek Dr Ste 100, Columbus, OH 43207 | 2018-04-30 |
| 1962897769 | Laura Lynn Mcneil | Nurse Practitioner | 1791 Alum Creek Dr Ste 100, Columbus, OH 43207 | 2015-03-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366947913 | Mary Elise Hanks | Internal Medicine | Osumc/nationwide Children's Med-ped Residency Program, 1405 S. High St, Columbus, OH 43207 | 2018-03-27 |
| 1699279323 | Timothy Ming-li Pian | Internal Medicine | Internal Medicine-pediatric Residency Program, 1405 S. High Street, Columbus, OH 43207 | 2018-03-19 |
| 1093245763 | Royce Scott | Home Health | 254 E. Barthman Ave, Columbus, OH 43207 | 2017-06-15 |
| 1497207930 | Vernon C Murphy Jr. | Counselor | 1430 S High St Suite 112, Columbus, OH 43207 | 2016-11-01 |
| 1669825931 | Ayamba Roselyn Tanyi | Social Worker | 1791 Alum Creek Drive, Columbus, OH 43207 | 2016-07-21 |
| 1629421268 | Tiffany Dawn Hinkle | Counselor | 1430 S. High St, Suite 112, Columbus, OH 43207 | 2016-07-19 |
| 1457714933 | Matthew Isaac Lyons | Internal Medicine | 1405 S. High St., Osu/nch Internal Medicine-pediatric Residency Prog., Columbus, OH 43207 | 2016-04-01 |
| 1053712976 | A Plus Children's Academy Community School | Local Education Agency (LEA) | 110 Obetz Rd., Columbus, OH 43207 | 2014-09-10 |
| 1407274301 | William Hamilton Marshall V | Student in an Organized Health Care Education/Training Program | 1405 South High St, South High Primary Care Center, Columbus, OH 43207 | 2014-03-29 |
| 1912249665 | Laura Romcevich | Internal Medicine | 700 Children's Dr. Ed650a, Osu/nch Internal Medicine-pediatric Residency Prog., Columbus, OH 43207 | 2013-03-20 |
| Find all providers in zip 43207 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518566900 | Melissa Nameth | Nurse Practitioner | 3003 Cortona Rd, Columbus, OH 43204-4898 | 2020-10-18 |
| 1962019901 | Joshua Peltier | Nurse Practitioner | 2657 Summit St, Columbus, OH 43202-2434 | 2020-09-24 |
| 1891302949 | Lindsay Baughman | Nurse Practitioner | 5866 Regency Dr, Columbus, IN 47203-4551 | 2020-09-23 |
| 1114530706 | Renee Dawn Holloway-vaughan | Nurse Practitioner | 1317 Antietam Dr, Columbus, GA 31907-6887 | 2020-08-25 |
| 1063024354 | Nathaniel Z Raidel | Nurse Practitioner | 5699 Sandalwood Blvd, Columbus, OH 43229-3420 | 2020-08-19 |
| 1174134332 | Hailey Lyn Holman | Nurse Practitioner | 5141 W Broad St Ste 130, Columbus, OH 43228-1984 | 2020-08-12 |
| 1508475989 | Kara Shroff | Nurse Practitioner | 1127 Dublin Rd, Columbus, OH 43215-1005 | 2020-07-30 |
| 1265050553 | Mary Hoobler | Nurse Practitioner | 5059 N High St, Columbus, OH 43214-1589 | 2020-07-13 |
| 1417575200 | Candice Kilbarger | Nurse Practitioner | 2329 Keep Pl, Columbus, OH 43204-4989 | 2020-07-08 |
| 1295351872 | Christina Cotterman | Nurse Practitioner | 700 Children Dr, Columbus, OH 43205 | 2020-06-19 |
| Find all providers in COLUMBUS | ||||
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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.