KORY JACKSON (NPI# 1669823068) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669823068 |
| Entity Type | Individual |
| Full Name | KORY JACKSON |
| Other Name | KORY MAYO |
| Credential | NP |
| Practice Address |
900 Main St Ste 100 Peoria IL 61602-1005 |
| Practice Telephone | 3096724908 |
| Mailing Telephone | 3096724908 |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2016-06-27 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LG0600X |
Nurse Practitioner Specialization: Gerontology |
209014384 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
900 MAIN ST STE 100 |
| City | PEORIA |
| State | IL |
| Zip Code | 61602-1005 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295260784 | Alexandra Gens | Psychiatry & Neurology | 900 Main St, Suite 720, Peoria, IL 61602-1005 | 2017-04-22 |
| 1407380751 | Unitypoint Health Methodist | Psychiatry & Neurology | 900 Main St, Suite 720, Peoria, IL 61602-1005 | 2017-04-13 |
| 1932554714 | Jamie Schupbach | Nurse Practitioner | 900 Main St, Ste 600, Peoria, IL 61602-1005 | 2016-04-28 |
| 1407223969 | Teresa Michelle Watts | Nurse Practitioner | 900 Main St, Suite 100, Peoria, IL 61602-1005 | 2015-08-31 |
| 1487054433 | Christina Lowrance | Nurse Practitioner | 900 Main St, Peoria, IL 61602-1005 | 2014-08-27 |
| 1295158194 | Karolina Wozny | Physician Assistant | 900 Main St, Suite 630, Peoria, IL 61602-1005 | 2014-01-28 |
| 1821423583 | Radha K Chathadi | Registered Nurse | 900 Main St, Suite 630, Peoria, IL 61602-1005 | 2013-09-12 |
| 1558796789 | Erin Surratt | Social Worker | 900 Main St, Suite 400, Peoria, IL 61602-1005 | 2013-09-06 |
| 1336490333 | Susan Copp | Nurse Practitioner | 900 Main St, Suite 600, Peoria, IL 61602-1005 | 2012-10-01 |
| 1831440395 | Lydia Bertschi | Nurse Practitioner | 900 Main St, Suite 630, Peoria, IL 61602-1005 | 2012-09-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720574676 | Critical Care Rx, LLC | Pharmacy | 126 Oak St, Peoria, IL 61602 | 2018-07-03 |
| 1235675836 | Cheryl Beckman | Registered Nurse | 211 Fulton Street, Suite 207, One Technology Plaza, Peoria, IL 61602 | 2017-01-06 |
| 1063957942 | Rosemary Ince | Registered Nurse | 211 Fulton St. Suite 207, One Technology Plaza, Peoria, IL 61602 | 2016-12-30 |
| 1962674820 | Lisa Jean Burckhartzmeyer | Psychiatry & Neurology | 228 Ne Jefferson St, Peoria, IL 61602 | 2008-03-31 |
| 1669503587 | Jill Larson | Counselor | 330 Sw Washington Street, Peoria, IL 61602 | 2007-03-09 |
| 1265407399 | Cardiac Consultants Sc | Internal Medicine | 900 Main Street, Suite 320, Peoria, IL 61602 | 2006-02-22 |
| 1013364470 | Rafal Szymczuk | Student in an Organized Health Care Education/Training Program | 900 Main Street, Suite 720, Peoria, IL 61602 | 2016-05-16 |
| 1043693831 | Kari Beth Watts | Family Medicine | 815 Main St, Peoria, IL 61602 | 2015-06-30 |
| 1881072791 | Kristen Dent | Family Medicine | 815 Main St, Peoria, IL 61602 | 2015-05-12 |
| 1023422797 | Andrew Wang | Psychiatry & Neurology | 900 Main St Ste 580, Peoria, IL 61602 | 2014-06-20 |
| Find all providers in zip 61602 | ||||
| Taxonomy Code | 363LG0600X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Gerontology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891797767 | Colleen M. Gray | Nurse Practitioner | 8227 W Sweetwater Ave, Peoria, AZ 85381-4936 | 2005-08-11 |
| 1386129328 | Debra Sharene Corley | Nurse Practitioner | 9139 W Thunderbird Rd Ste 265, Peoria, AZ 85381-4922 | 2018-09-25 |
| 1164912762 | Melissa Dela Torre | Nurse Practitioner | 4306 N Sheridan Rd, Peoria, IL 61614 | 2018-05-18 |
| 1033608872 | Melinda Bahler | Nurse Practitioner | 900 Main St Ste 630, Peoria, IL 61602-5024 | 2018-05-08 |
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| 1083222368 | Izolda Rosario | Nurse Practitioner | 501 W Lake St Ste 207, Elmhurst, IL 60126-1419 | 2020-07-22 |
| 1043832785 | Melanie Glander | Nurse Practitioner | 18357 Cowing Ct, Homewood, IL 60430-3332 | 2020-05-16 |
| 1699306902 | Ife Muyiwa-ojo | Nurse Practitioner | 729 E Carpenter St, Springfield, IL 62702-5321 | 2020-01-27 |
| 1962040345 | Doctors Orders Inc. | Nurse Practitioner | 5113 S Harper Ave Ste 2, Chicago, IL 60615-4119 | 2019-12-16 |
| 1801455993 | Parul Arora | Nurse Practitioner | 1717 W Congress Pkwy Ste 1125, Chicago, IL 60612-3809 | 2019-06-11 |
| 1891358222 | Kelly Jo Erke | Nurse Practitioner | 20830 N 1970 East Rd, Danville, IL 61834-6228 | 2019-04-22 |
| 1689136319 | Brittany Sue Borkowski | Nurse Practitioner | 5841 S Maryland Ave # W700, Chicago, IL 60637-1443 | 2019-04-02 |
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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.