MRS. JACKLENE JACKSON (NPI# 1386183416) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386183416 |
| Entity Type | Individual |
| Full Name | MRS. JACKLENE JACKSON |
| Other Name | JACKLENE LIGHT |
| Credential | RN |
| Practice Address |
1270 Kot-num Rd. Warm Springs OR 97761 |
| Mailing Address |
Po Box C Warm Springs OR 97761-3001 |
| Practice Telephone | 5415531196 |
| Mailing Telephone | 5415531196 |
| Enumeration Date | 2017-02-22 |
| Last Update Date | 2017-02-22 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 163WC1500X |
Registered Nurse Specialization: Community Health |
201242738RN | OR | Nursing Service Providers |
| Street Address |
1270 KOT-NUM RD. |
| City | WARM SPRINGS |
| State | OR |
| Zip Code | 97761 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952303273 | Stephen Miles Rudd | Family Medicine | 1270 Kot-num Rd., Warm Springs, OR 97761 | 2005-06-01 |
| 1740829563 | Kathleen Boxx | Dietitian, Registered | 1270 Kot-num Rd., Warm Springs, OR 97761 | 2019-12-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891850749 | Frank A Mendoza | Dentist | Warm Springs Indian Health Service Dental Clinic, 1270 Kot-num Road, Warm Springs, OR 97761 | 2006-12-22 |
| 1477596112 | Eric Bradford | Physical Therapist | 1270 Kotnum Rd., Warm Springs, OR 97761 | 2006-06-13 |
| 1629033527 | Lynette R Dziuk | Optometrist | 1270 Kot Num Rd, Warm Springs, OR 97761 | 2006-04-20 |
| 1982690954 | Hai Tuan Tran | Podiatrist | 1270 Kot-num, Warm Springs, OR 97761 | 2005-09-23 |
| 1154320240 | James C Gemelas | Pharmacist | 1270 Kotnum Rd, Warm Springs, OR 97761 | 2005-07-20 |
| 1144229154 | Frank Charles Hoffman | Emergency Medicine | 1270 Kot-num Rd, Warm Springs, OR 97761 | 2005-07-20 |
| 1508863317 | Mitzie Althea Allen | Pharmacist | 1270 Kotnum Road, Warm Springs, OR 97761 | 2005-07-07 |
| 1184239956 | Brian Daniel Wojahn | Dentist | 1270 Kot-num Rd, Warm Springs, OR 97761 | 2020-09-09 |
| 1639789266 | Kasem Darwish El-hajji | Pharmacist | 1270 Kot-num Rd, Warm Springs, OR 97761 | 2020-08-07 |
| 1376199398 | The Confederated Tribes of The Warm Springs Reservation of Oregon | Physical Therapist | 2124 Warm Springs St., Warm Springs, OR 97761 | 2019-08-15 |
| Find all providers in zip 97761 | ||||
| Taxonomy Code | 163WC1500X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | Community Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013439785 | Janet Marie Bissell | Registered Nurse | 1270 Kot Num Rd, Warm Springs, OR 97761 | 2017-07-13 |
| 1962932954 | Brenda Lu Howe | Registered Nurse | 1270 Kotnum Rd, Warm Springs, OR 97761-3001 | 2017-06-13 |
| 1750821831 | Jane Seaders | Registered Nurse | 1270 Kotnum Rd., Warm Springs, OR 97761 | 2017-03-08 |
| 1114014644 | Johanna Ellen Fickett | Registered Nurse | 1270 Kot-num Rd, Warm Springs, OR 97761 | 2006-10-06 |
| 1144323429 | Shawn Gaddy Winsor | Registered Nurse | 1270 Kotnum Road, Warm Springs, OR 97761 | 2006-09-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316556574 | Anne Marie Wilson | Registered Nurse | 3664 Fairhaven Dr, West Linn, OR 97068-3779 | 2020-07-23 |
| 1275157604 | Lauralee St Clair | Registered Nurse | 35398 S Dickey Prairie Rd, Molalla, OR 97038-8627 | 2020-06-01 |
| 1073149928 | Ann De Voir | Registered Nurse | 2905 Sw Greenway Ave, Portland, OR 97201-1452 | 2020-03-22 |
| 1477184695 | Brenda Rasczewski | Registered Nurse | 3235 6th St, Columbia City, OR 97018-9703 | 2020-01-27 |
| 1669011706 | Amanda Ervin | Registered Nurse | 1485 Nw Penny Ln, Albany, OR 97321-1170 | 2020-01-06 |
| 1538707187 | Alison Marie Larson | Registered Nurse | 46780 Nw Graham Rd, Banks, OR 97106-7029 | 2019-12-13 |
| 1972149482 | Kendra Dee Falk | Registered Nurse | 2152 Lomond Ave, Springfield, OR 97477-2579 | 2019-11-19 |
| 1790328003 | Bethanie Robbins Girardi | Registered Nurse | 748 Little Oak St, Newberg, OR 97132-7476 | 2019-10-21 |
| 1124669288 | Andrea Marie Lanning | Registered Nurse | 60847 Love Rd, Cove, OR 97824-8210 | 2019-09-30 |
| 1164070595 | Yvonne M Myette | Registered Nurse | 14834 Nw Orchid St, Portland, OR 97229-6941 | 2019-08-28 |
| Find all providers with the same taxonomy | ||||
| City | WARM SPRINGS |
| Zip Code | 97761 |
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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.