DR. KENNETH WADE JACKSON JR. (NPI# 1487606943) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487606943 |
| Entity Type | Individual |
| Full Name | DR. KENNETH WADE JACKSON JR. |
| Credential | M.D. |
| Practice Address |
22 Manningfield Dr Fletcher NC 28732-9457 |
| Mailing Address |
Po Box 1869 Fletcher NC 28732-1869 |
| Practice Telephone | 8287134944 |
| Mailing Telephone | 8286875698 |
| Mailing Fax Number | 8286508076 |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2018-03-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207VX0000X |
Obstetrics & Gynecology Specialization: Obstetrics |
9801313 | NC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | BLUE CROSS | 136RM | 01 |
| NC | CAQH | 11453742 | 01 |
| NC | UNITED HEALTHCARE | 2169383 | 01 |
| NC | 89136RM | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 15 Skyland Inn Dr Fl 2, Arden, NC 287047714 | 8286874500 | 8286874550 |
| 50 Hospital Dr Ste 4a, Hendersonville, NC 287925246 | 8286508077 | 8286510194 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174083810 | Kenneth Jason Jackson | Student in an Organized Health Care Education/Training Program | 320 23rd St S Apt 1418, Arlington, VA 22202-3773 | 2019-03-20 |
| 1639469026 | Kenneth T Jackson | Counselor | 25506 Virginia Dr, Warren, MI 48091-6002 | 2011-04-19 |
| 1396968863 | Kenneth J Jackson | Dentist | 809 Redskin Trail, Wapakoneta, OH 45895 | 2007-04-11 |
| 1972510352 | Kenneth Wayne Jackson | Nurse Practitioner | 1811 Memorial Dr, Clarksville, TN 37043-4604 | 2006-08-01 |
| 1275514994 | Kenneth Conrad Jackson II | Pharmacist | 546 Chipeta Way, Suite 220, Salt Lake City, UT 84108-1236 | 2005-11-09 |
| 1407409063 | Kenneth Jackson | Technician | 1005 Terminal Way Ste 125, Reno, NV 89502-2198 | 2019-07-22 |
| 1457857690 | Kenneth D Jackson | Counselor | 2775 State Route 39, Shelby, OH 44875-9466 | 2018-04-05 |
| 1528573714 | Kenneth Jackson | Case Manager/Care Coordinator | 1501 Madison Rd, Walnut Hills, OH 45206-1706 | 2017-12-10 |
| 1003328550 | Kenneth Lee Jackson Jr. | Counselor | 1430 S High St Fl 4, Columbus, OH 43207-1045 | 2017-10-24 |
| 1942674411 | Kenneth David Jackson Jr. | Case Manager/Care Coordinator | 3901 Ulloa St, New Orleans, LA 70119-6942 | 2015-11-21 |
| Street Address |
22 MANNINGFIELD DR |
| City | FLETCHER |
| State | NC |
| Zip Code | 28732-9457 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689198772 | Recovery On The Ridge LLC | Substance Abuse Rehabilitation Facility | 2145 Cane Creek Rd., Fletcher, NC 28732 | 2017-07-31 |
| 1790227643 | John Michael Lim Tamaray | Physical Therapist | 212 Riverbirch Drive, Fletcher, NC 28732 | 2016-11-09 |
| 1164891479 | Christina Leigh Murray | Pharmacist | 108 Cottage Ridge Road, Fletcher, NC 28732 | 2015-09-16 |
| 1801208103 | Sciteck Clinical Laboratories Inc | Clinical Medical Laboratory | 317 Rutledge Road, Fletcher, NC 28732 | 2014-05-21 |
| 1073881371 | Steve Worley Enterprises LLC Dba Comfort Keepers of Asheville | Home Health | 450 Airport Rd, Fletcher, NC 28732 | 2011-12-01 |
| 1699051995 | Jsa Associates, Inc | Home Health | 103 Underwood Rd, Suite J, Fletcher, NC 28732 | 2011-10-31 |
| 1275708703 | W Raymond Chavez | Chiropractor | 845 Howard Gap Road, Fletcher, NC 28732 | 2008-04-25 |
| 1346456704 | Edith Leona Herzel | Physical Therapist | 13 Gun Flint Tr, Fletcher No 2, Fletcher, NC 28732 | 2007-05-15 |
| 1407078397 | Stacy Ann Small | Speech-Language Pathologist | 4020 Hendersonville Road Ste. B, Fletcher, NC 28732 | 2007-05-02 |
| 1710011549 | Kari Alford Williams | Dentist | 3272 Hendersonville Rd., Suite A, Fletcher, NC 28732 | 2007-03-15 |
| Find all providers in zip 28732 | ||||
| Taxonomy Code | 207VX0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| Specialization | Obstetrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942757034 | Stacie Walker | Obstetrics & Gynecology | 4414 Lake Boone Trl Ste 311, Raleigh, NC 27607 | 2016-09-06 |
| 1245599273 | Jessica Son | Obstetrics & Gynecology | 204 Oakwood Ct, Winston Salem, NC 27103-1955 | 2012-05-11 |
| 1124192737 | Peter F Mcilveen | Obstetrics & Gynecology | 942 Johnson Ridge Rd, Elkin, NC 28621-2212 | 2006-11-17 |
| 1689663999 | Charles Augustus Harper Jr. | Obstetrics & Gynecology | 706 Green Valley Road, Suite 506, Greensboro, NC 27408-7023 | 2005-10-19 |
| 1669474268 | Laurie May Marston | Obstetrics & Gynecology | 2304 Wesvill Ct, Ste 210, Raleigh, NC 27607-2973 | 2005-08-12 |
| 1861498354 | John Davis Hepler | Obstetrics & Gynecology | 300 W 27th St, Lumberton, NC 28358-3075 | 2005-06-21 |
| 1942766886 | Watina D Gibbs | Obstetrics & Gynecology | 501 E Green Dr, High Point, NC 27260-6707 | 2019-02-15 |
| 1346760675 | Trisha Ann Dmytruk | Obstetrics & Gynecology | 11840 Southmore Dr Ste 100, Charlotte, NC 28277-4821 | 2017-06-27 |
| 1679012660 | Novant Medical Group, Inc. | Obstetrics & Gynecology | 6324 Fairview Rd Ste 430, Charlotte, NC 28210-4278 | 2017-02-23 |
| 1972974509 | Cape Fear Physician Services, Inc. | Obstetrics & Gynecology | 2221 S 17th St, Wilmington, NC 28401-7542 | 2015-10-08 |
| Find all providers with the same taxonomy | ||||
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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.