DR. TIMOTHY K JACKSON (NPI# 1255444766) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255444766 |
| Entity Type | Individual |
| Full Name | DR. TIMOTHY K JACKSON |
| Credential | M. D. |
| Practice Address |
710 Genesis Blvd Bridgeport WV 26330-9668 |
| Mailing Address |
Po Box 763 Morgantown WV 26507-0763 |
| Practice Telephone | 6813423070 |
| Mailing Telephone | 8005414009 |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2020-06-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RE0101X |
Internal Medicine Specialization: Endocrinology, Diabetes & Metabolism |
13532 | WV | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WV | 0084315000 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1 Stadium Drive, Morgantown, WV 26507 | 3045984800 | 3042936963 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124338504 | Timothy Lawrence Jackson | Physician Assistant | 2722 N Mariah Way, Flagstaff, AZ 86004-7550 | 2010-10-19 |
| 1972610947 | Timothy Michael Jackson | Dentist | 982 Drayton Avenue, Elba, AL 36323 | 2006-08-24 |
| 1982623625 | Timothy L Jackson | Physician Assistant | 5249 Providence Rd, Virginia Beach, VA 23464-4201 | 2006-07-19 |
| 1093710089 | Timothy D Jackson | Orthopaedic Surgery | 12080 New Orleans Ave N, Gulfport, MS 39503-3180 | 2005-06-16 |
| 1710473368 | Timothy Jackson | Registered Nurse | 1644 Central Ave, Mckinleyville, CA 95519-4342 | 2018-07-06 |
| 1336634641 | Timothy Jackson | Social Worker | 3820 Nine Mile Rd, Richmond, VA 23223-4831 | 2018-06-28 |
| 1538512520 | Timothy Jackson | Physical Therapist | 97 Gateway Business Park Dr, Ringgold, GA 30736-7395 | 2016-07-14 |
| 1538485396 | Timothy William Jackson | Counselor | 115 Liberty St, Bath, NY 14810-1508 | 2010-04-19 |
| 1598997751 | Timothy William Jackson | Physical Therapist | 8918 Blakeney Professional Dr, Suite 120, Charlotte, NC 28277-6691 | 2009-08-20 |
| 1679704001 | Timothy D Jackson | Surgery | Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114 | 2009-08-03 |
| Street Address |
710 GENESIS BLVD |
| City | BRIDGEPORT |
| State | WV |
| Zip Code | 26330-9668 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487168795 | Meranda Chipps | Nurse Practitioner | 710 Genesis Blvd, Bridgeport, WV 26330-9668 | 2017-11-22 |
| 1871969717 | Carol Mclennan | Nurse Practitioner | 710 Genesis Blvd, Bridgeport, WV 26330-9668 | 2015-08-14 |
| 1811332166 | John Blake Epling | Internal Medicine | 710 Genesis Blvd, Bridgeport, WV 26330-9668 | 2013-04-30 |
| 1245585207 | Aaradhana Kaul | Internal Medicine | 710 Genesis Blvd, Bridgeport, WV 26330-9668 | 2012-07-16 |
| 1346447943 | Kristen Nicole Moore | Internal Medicine | 710 Genesis Blvd, Bridgeport, WV 26330-9668 | 2007-06-28 |
| 1780767772 | United Hospital Center | Internal Medicine | 710 Genesis Blvd, Bridgeport, WV 26330-9668 | 2006-10-23 |
| 1679672505 | Premier Medical Group, Inc. | Clinical Medical Laboratory | 710 Genesis Blvd, Bridgeport, WV 26330-9668 | 2006-09-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992303036 | Gage Mackenzie Chichester | Nurse Anesthetist, Certified Registered | 2673 Medical Park Drive, Bridgeport, WV 26330 | 2020-10-12 |
| 1851914105 | Melany Langhurst | Social Worker | 64 Professional Place, Suite 102, Bridgeport, WV 26330 | 2020-05-21 |
| 1245704980 | Adam Christopher Stonestreet | Social Worker | Community Care of Bridgeport, 65 Professional Place, Bridgeport, WV 26330 | 2019-01-16 |
| 1588146658 | Bridgeport Physical Therapy Services, Inc. | Occupational Therapist | 25 Sweetbrier Lane, Suite 105, Bridgeport, WV 26330 | 2018-09-05 |
| 1275040685 | White Oaks Assisted Living | Assisted Living Facility | 140 Professional Place White Oaks, Bridgeport, WV 26330 | 2018-01-08 |
| 1275049371 | Regional Eye Associates, Inc | Ophthalmology | 220 Southview Drive, Bridgeport, WV 26330 | 2017-12-27 |
| 1528586187 | Savanna Tamia Brown | Social Worker | 65 Professinal Place Suites 101,102103, Bridgeport, WV 26330 | 2017-09-05 |
| 1184079642 | Karla Kay Rinehart | Social Worker | 27 Trovato St., Suite 103, Bridgeport, WV 26330 | 2016-05-03 |
| 1396176756 | Willo Group LLC | Pharmacy | 460 E. Main Street, Bridgeport, WV 26330 | 2013-12-10 |
| 1891031878 | Sherri Michelle Dobson | Occupational Therapy Assistant | 1000 Maplewood Dr, Bridgeport, WV 26330 | 2012-12-20 |
| Find all providers in zip 26330 | ||||
| Taxonomy Code | 207RE0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Endocrinology, Diabetes & Metabolism |
| An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467560326 | Jeremy B Soule | Internal Medicine | 16 Sterling Dr, Suite 102, Bridgeport, WV 26330-9132 | 2006-08-29 |
| 1811332166 | John Blake Epling | Internal Medicine | 710 Genesis Blvd, Bridgeport, WV 26330-9668 | 2013-04-30 |
| 1659524635 | Advanced Diabetes & Endocrine Center | Internal Medicine | 527 Medical Park Drive, Suite 103, Bridgeport, WV 26330-9009 | 2008-11-04 |
| 1437314457 | Christos Paras | Internal Medicine | 2800 Main St, Bridgeport, CT 06606-4201 | 2008-07-21 |
| 1760679054 | Endocrinology Asscociates of Southern Ct, LLC | Internal Medicine | 3715 Main St, Bridgeport, CT 06606-3611 | 2007-10-01 |
| 1881709970 | Syed N Haq | Internal Medicine | 527 Medical Park Drive, Suite 103, Bridgeport, WV 26330-9009 | 2006-08-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710365549 | Novus Healthcare, Inc. | Internal Medicine | 307 Medical Ct, Martinsburg, WV 25401-2843 | 2015-05-13 |
| 1265785737 | William M Jennings IIi | Internal Medicine | 1448 10th Avenue, Suite 100, Huntington, WV 25704 | 2012-10-22 |
| 1831400761 | Gilbert Alexander Fleming | Internal Medicine | 550 East Ridge Street, Harpers Ferry, WV 25425-1260 | 2010-06-25 |
| 1548478993 | Emma Morton-eggleston | Internal Medicine | 880 N Tennessee Ave Ste 110a, Martinsburg, WV 25401-9401 | 2007-05-18 |
| 1043396229 | Philip J A Ryan | Internal Medicine | 176 Health Care Ln, Suite B, Martinsburg, WV 25401-4010 | 2006-10-31 |
| 1225132681 | Lee Ann Skaff | Internal Medicine | 4922 Maccorkle Ave Se, Charleston, WV 25304 | 2006-09-07 |
| 1639272594 | Irma Ullrich | Internal Medicine | 209 Poplar Drive, Morgantown, WV 26505 | 2006-09-06 |
| 1962424903 | Raghda Tolaymat Sahloul | Internal Medicine | 4400 Maccorkle Avenue S.e., Charleston, WV 25304-1223 | 2006-07-25 |
| 1811922362 | Mary Elizabeth Faw | Internal Medicine | 3825 Teays Valley Road, Suite 100, Hurricane, WV 25526 | 2006-07-12 |
| 1871523241 | Frank Lee Schwartz | Internal Medicine | 604 Ann Street, Parkersburg, WV 26101 | 2006-07-03 |
| Find all providers with the same taxonomy | ||||
| City | BRIDGEPORT |
| Zip Code | 26330 |
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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.