KELLY JACKSON (NPI# 1497108310) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1497108310 |
Entity Type | Individual |
Full Name | KELLY JACKSON |
Other Name | KELLY ABDULLAH |
Credential | LMT |
Practice Address |
1325 San Marco Blvd Suite 102 Jacksonville FL 32207-8568 |
Practice Telephone | 9048587045 |
Mailing Telephone | 9048587045 |
Enumeration Date | 2016-07-15 |
Last Update Date | 2016-07-15 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA61239 | FL | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1588036263 | Kelly Jackson | Social Worker | 2937 Ne 16th Ter, Gainesville, FL 32609-3234 | 2015-10-21 |
1477896876 | Kelly A Jackson | Occupational Therapist | 178 Manila Ave, Staten Island, NY 10306-5608 | 2013-04-03 |
1104986793 | Kelly A Jackson | Chiropractor | 190 North Main Street, Natick, MA 01760 | 2006-12-12 |
1518982487 | Kelly Donald Jackson | Dentist | 3023 Eastland Blvd Ste 112, Clearwater, FL 33761-4106 | 2006-07-13 |
1689273310 | Kelly Jackson | Behavior Technician | 27777 Inkster Rd Ste 100, Farmington Hills, MI 48334-5312 | 2020-10-23 |
1629544655 | Kelly Colleen Jackson | Counselor | 811 Madison St, Everett, WA 98203-4543 | 2018-10-17 |
1619457926 | Kelly Jackson | Physician Assistant | 12300 Mccracken Rd, Garfield Heights, OH 44125-2975 | 2018-08-16 |
1760961833 | Kelly D Jackson | Licensed Practical Nurse | 602 W Semands St, Conroe, TX 77301-1867 | 2018-08-09 |
1841780178 | Kelly Amanda Jackson | Nurse Practitioner | 1700 Medical Center Pkwy, Murfreesboro, TN 37129-2245 | 2018-05-11 |
1033653431 | Kelly Jackson | Nurse Practitioner | 606 W Columbia St, San Augustine, TX 75972-1709 | 2016-12-05 |
Street Address |
1325 SAN MARCO BLVD SUITE 102 |
City | JACKSONVILLE |
State | FL |
Zip Code | 32207-8568 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1730183500 | Philip R. Hardy | Orthopaedic Surgery | 1325 San Marco Blvd, Ste 200, Jacksonville, FL 32207-8566 | 2005-06-09 |
1730794496 | Rachel Keene | Specialist/Technologist | 1325 San Marco Blvd, Jacksonville, FL 32207-8568 | 2020-09-10 |
1396201638 | Neutt Dellareeda King | Nurse Practitioner | 1325 San Marco Blvd, Jacksonville, FL 32207-8568 | 2019-02-12 |
1396282836 | Peter Christopher Mcdermott | Nurse Practitioner | 1325 San Marco Blvd, 300, Jacksonville, FL 32207-8568 | 2017-01-23 |
1215472014 | Lindsay Moore | Nurse Practitioner | 1325 San Marco Blvd, Reid Building Ste 300, Jacksonville, FL 32207-8568 | 2017-01-03 |
1659828994 | Aimee Roberts-serrato | Nurse Practitioner | 1325 San Marco Blvd, Suite 200, Jacksonville, FL 32207-8568 | 2016-09-03 |
1265985030 | Laran Phelps | Massage Therapist | 1325 San Marco Blvd, Suite 102, Jacksonville, FL 32207-8568 | 2016-07-28 |
1376902221 | Joshua Jackson | Nurse Practitioner | 1325 San Marco Blvd, Reid Bldg., Suite 300, Jacksonville, FL 32207-8568 | 2016-02-21 |
1063889814 | Emily Lisa Rea | Nurse Practitioner | 1325 San Marco Blvd, Reid Building Suite 300, Jacksonville, FL 32207-8568 | 2015-08-27 |
1194192153 | Venessa Carmel | Physical Therapist | 1325 San Marco Blvd, Suite 102, Jacksonville, FL 32207-8568 | 2015-08-26 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1033768981 | North Florida Pediatrics, Pa | Pediatrics | 4501 Atlantic Boulevard, Jacksonville, FL 32207 | 2019-09-04 |
1578117024 | Pragna Mukesh Dholakia | Nurse Practitioner | 2624 Atlantic Blvd., Jacksonville, FL 32207 | 2019-08-01 |
1821653601 | The Adoption Authority, Inc. | Case Management | 4940 Emerson Street, Suite 103, Jacksonville, FL 32207 | 2019-05-07 |
1255896080 | Elizabeth Lynn Houghton | Social Worker | Sulzbacher Village, 904-720-2079, Jacksonville, FL 32207 | 2019-02-06 |
1902374630 | Guilherme Jose Agnoletto | Neurological Surgery | 800 Prudential Drive Weaver Tower 11th Floor, Jacksonville, FL 32207 | 2018-11-12 |
1073008504 | Pavilion Infusion Therapy Inc | Durable Medical Equipment & Medical Supplies | 1301 Palm Avenue, Suite 220, Jacksonville, FL 32207 | 2018-06-27 |
1346733185 | Dueseason1 | Registered Nurse | 4058 Saint Augustine Rd, Jacksonville, FL 32207 | 2018-06-06 |
1164911913 | Eric Lang Poovey | Nurse Practitioner | Baptist Heart Specialists, 836 Prudential Drive Suite 1700, Jacksonville, FL 32207 | 2018-05-08 |
1902311046 | Spring Park Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 3851 Emerson St Ste 13, Jacksonville, FL 32207 | 2017-12-12 |
1295247948 | Emed Urgent and Primary Care Pa | Clinic/Center | 2570 Atlantic Boulevard, Jacksonville, FL 32207 | 2017-11-02 |
Find all providers in zip 32207 |
Taxonomy Code | 225700000X |
Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Classification | Massage Therapist |
An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1376142299 | Undra Williams | Massage Therapist | 5900 Townsend Rd Apt 813, Jacksonville, FL 32244-4579 | 2020-10-21 |
1356958771 | Jared Franklin | Massage Therapist | 1540 El Prado Rd Apt 1, Jacksonville, FL 32216-2965 | 2020-09-29 |
1043826613 | Eric Gene Thompson | Massage Therapist | 2386 Villanova Cir # Na, Jacksonville, FL 32218-5123 | 2020-09-19 |
1720693757 | Cathleen Ann Smith | Massage Therapist | 13051 Gran Bay Pkwy Unit 2321, Jacksonville, FL 32258-6520 | 2020-09-15 |
1720693286 | Paul Andrew Hudson | Massage Therapist | 13108 Harborton Dr, Jacksonville, FL 32224-7403 | 2020-09-11 |
1063026748 | Sandra Nicole Frye | Massage Therapist | 5894 Long Branch Rd, Jacksonville, FL 32234 | 2020-09-01 |
1104437821 | Crystal Delgado Mccraw | Massage Therapist | 869 Stockton St Ste 8, Jacksonville, FL 32204-3590 | 2020-08-14 |
1538787866 | Tywanna Council | Massage Therapist | 4720 Salisbury Road #102, Jacksonville, FL 32256 | 2020-07-13 |
1659904514 | Kyoko Provencio | Massage Therapist | 136 Gregory Pl, Jacksonville, AR 72076-3212 | 2020-02-19 |
1750933529 | James Bradley Toon | Massage Therapist | 12443 San Jose Blvd Ste 801, Jacksonville, FL 32223-8654 | 2019-07-11 |
Find all providers in JACKSONVILLE |
City | JACKSONVILLE |
Zip Code | 32207 |
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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.