STACIE JACKSON (NPI# 1538683909) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538683909 |
| Entity Type | Individual |
| Full Name | STACIE JACKSON |
| Credential | PA-C |
| Practice Address |
6500 West 29th St Ste 106 Greeley CO 80634 |
| Mailing Address |
6500 West 29th St Ste 106 Greeley CO 80634-8386 |
| Practice Telephone | 9703305555 |
| Mailing Telephone | 9703305555 |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA.0005029 | CO | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 6500 29th St Ste 106, Greeley, CO 806348386 | (970) 330-5555 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225202393 | Stacie W Jackson | Occupational Therapist | 719 Heritage Park Ln, Hoover, AL 35226-4198 | 2008-04-18 |
| 1467052266 | Stacie Rose Jackson | Case Manager/Care Coordinator | 3810 Rosin Ct Ste 170, Sacramento, CA 95834-1658 | 2020-10-29 |
| Street Address |
6500 WEST 29TH ST STE 106 |
| City | GREELEY |
| State | CO |
| Zip Code | 80634 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831707843 | Witting Medical, LLC | Pathology | 17 Dos Rios, Greeley, CO 80634 | 2020-07-15 |
| 1730706102 | Heart Centered Counseling | Counselor | 1770 W 25th Street #206, Greeley, CO 80634 | 2020-07-01 |
| 1396374237 | Kidstuff Child and Family Counseling, P.C. | Counselor | 1770 25th Ave., Ste. 102, Greeley, CO 80634 | 2020-04-03 |
| 1164055745 | Stephanie Alexis Balunda | Speech-Language Pathologist | Uchealth Physical Therapy and Rehabilitation Clinic, 6767 West 29th St., Greeley, CO 80634 | 2020-02-21 |
| 1407413727 | Stephen P Street Pllc | Counselor | 4657 W. 20th Street, Unit B, Greeley, CO 80634 | 2019-05-22 |
| 1043797749 | Burt Stewart Dmd Pllc | Clinic/Center | 6937 West 10th Street, Greeley, CO 80634 | 2018-07-25 |
| 1164913885 | Innovations Pediatric Therapy, LLC | Occupational Therapist | 3403 W 7th St Apt A, Greeley, CO 80634 | 2018-05-29 |
| 1003305319 | Austin Michael Lake | Physical Therapist | 4681 W 20th St Unit 202b, Greeley, CO 80634 | 2018-05-02 |
| 1225542004 | Kevin Lichner | Specialist/Technologist | 522 28th Ave, Greeley, CO 80634 | 2017-11-30 |
| 1184173890 | Shawn Stratford | Occupational Therapist | 1014 32nd Ave, Greeley, CO 80634 | 2016-09-23 |
| Find all providers in zip 80634 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518319094 | Anne Margaret Stavros | Physician Assistant | 2520 W. 16th Street, Greeley, CO 80634 | 2016-07-07 |
| 1952653289 | Christopher Paul Wright | Physician Assistant | 6500 W 29th St, Suite 106, Greeley, CO 80634-8386 | 2012-10-10 |
| 1134339435 | Shawna Reeves | Physician Assistant | 2200 O St, Greeley, CO 80631-9503 | 2007-05-23 |
| 1326186065 | Cyndi R Desormeaux | Physician Assistant | 1620 25th Ave, Greeley, CO 80634-4960 | 2007-02-02 |
| 1104916923 | Colleen Ines Andrijiw | Physician Assistant | 6801 W 20th St Unit 208, Greeley, CO 80634 | 2006-10-13 |
| 1750305884 | Kimberly Townsend | Physician Assistant | 1624 17th Ave, Greeley, CO 80631-5129 | 2006-07-26 |
| 1659396984 | Stephen W Toth | Physician Assistant | 1011 39th Ave, Greeley, CO 80634-2504 | 2006-07-13 |
| 1689621195 | Debra A Dewall | Physician Assistant | 1675 18th Ave Ste 3, Greeley, CO 80631 | 2006-05-28 |
| 1689650574 | Alexandria Pekarek | Physician Assistant | 1551 N 17th Ave, Suite 1, Greeley, CO 80631-9400 | 2005-12-21 |
| 1245238716 | Herbert Elton Johnson | Physician Assistant | 5881 W 16th St, Suite D, Greeley, CO 80634-2910 | 2005-07-08 |
| Find all providers in GREELEY | ||||
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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.