JACKSON PEMBERTON (NPI# 1891781969) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891781969 |
| Entity Type | Individual |
| Full Name | JACKSON PEMBERTON |
| Credential | MD |
| Practice Address |
1 Medical Village Dr Edgewood KY 41017-3403 |
| Mailing Address |
Po Box 636324 Cincinnati OH 45263-6324 |
| Practice Telephone | 8593012018 |
| Practice Fax Number | 8593012073 |
| Mailing Telephone | 8593012018 |
| Mailing Fax Number | 8593012073 |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2018-09-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207ZP0101X |
Pathology Specialization: Anatomic Pathology |
25835 | KY | Allopathic & Osteopathic Physicians |
| Y | 207ZP0102X |
Pathology Specialization: Anatomic Pathology & Clinical Pathology |
25835 | KY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 2463507 | 05 | |
| KY | 64258353 | 05 |
| Street Address |
1 MEDICAL VILLAGE DR |
| City | EDGEWOOD |
| State | KY |
| Zip Code | 41017-3403 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669477279 | Gregory Dean Sweeney | Emergency Medicine | 1 Medical Village Dr, Edgewood, KY 41017-3403 | 2005-06-20 |
| 1497356182 | Mariah Gilbert | Registered Nurse | 1 Medical Village Dr, Edgewood, KY 41017-3403 | 2020-11-08 |
| 1730789132 | Bailey Hancock | Genetic Counselor, MS | 1 Medical Village Dr, Edgewood, KY 41017-3403 | 2020-10-27 |
| 1831799220 | Caroline Ewart | Genetic Counselor, MS | 1 Medical Village Dr, Edgewood, KY 41017-3403 | 2020-10-27 |
| 1437756442 | Danielle Brauning | Nurse Practitioner | 1 Medical Village Dr, Edgewood, KY 41017-3403 | 2020-10-02 |
| 1649887944 | Ashleigh Eversole | Nurse Practitioner | 1 Medical Village Dr, Edgewood, KY 41017-3403 | 2020-09-30 |
| 1164037784 | Elizabeth Spray | Nurse Practitioner | 1 Medical Village Dr, Edgewood, KY 41017-3403 | 2020-09-10 |
| 1508470360 | Michael Lavoy | Nurse Anesthetist, Certified Registered | 1 Medical Village Dr, Edgewood, KY 41017-3403 | 2020-08-31 |
| 1114538519 | Carrie Nicole Anderson | Genetic Counselor, MS | 1 Medical Village Dr, Floor 3 - Mfm, Edgewood, KY 41017-4101 | 2020-08-11 |
| 1396354569 | Timothy Robert Mcintyre | Nurse Anesthetist, Certified Registered | 1 Medical Village Dr, Edgewood, KY 41017-3403 | 2020-07-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578187209 | St. Elizabeth Medical Center, Inc. | Pharmacy | 1 Medical Village Dr., Edgewood, KY 41017 | 2020-05-28 |
| 1366084337 | St. Elizabeth Medical Center, Inc. | Pharmacy | 850 Thomas More Parkway, Edgewood, KY 41017 | 2019-10-11 |
| 1396396750 | Family First Vision Care Kentucky | Optometrist | 614 Buttermilk Pike, Fort Mitchell, KY 41017 | 2019-09-26 |
| 1083184543 | Katie Franconia Smith | Nurse Practitioner | 2865 Chancellor Dr., Crestview Hills, KY 41017 | 2018-11-27 |
| 1871077511 | Janet Reeves Martin | Nurse Practitioner | Infinity Dialysis, 4750 East Galbraith Rd. Suite 103, Cincinnati, OH 41017 | 2018-09-19 |
| 1144713983 | Kelly Wiechart | Dentist | 599 Freedom Park Dr Ste 100, Crestview Hills, KY 41017 | 2018-06-06 |
| 1225535966 | Proscan Radiology Northern Kentucky, LLC | Radiology | 350 Thomas More Pkwy Ste 170, Crestview Hills, KY 41017 | 2018-04-10 |
| 1396241626 | Tressa S. Leahy | Physical Therapist | 200 Medical Village Drive, Edgewood, KY 41017 | 2018-04-04 |
| 1699294470 | Raymond Gardinier | Physical Therapist | 3755 Old Ky 17, Fort Wright, KY 41017 | 2017-09-13 |
| 1992229785 | Adrienne Bussard | Physician Assistant | 334 Thomas More Pkwy Ste 120, Crestview Hills, KY 41017 | 2017-08-02 |
| Find all providers in zip 41017 | ||||
| Taxonomy Code | 207ZP0102X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pathology |
| Specialization | Anatomic Pathology & Clinical Pathology |
| A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added, 7/1/2009: definition reformatted] Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/ This taxonomy code identifies the combined anatomic pathology & clinical pathology route. Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology. To acknowledge the diverse activities in the practice of pathology and to accommodate the interests of individuals wanting to enter the field, the ABP offers primary certification through the following three routes: combined anatomic pathology and clinical pathology, anatomic pathology only and clinical pathology only. Primary certification in anatomic pathology or clinical pathology may be combined with some of the subspecialty certifications. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104262880 | Rasha Salama | Pathology | 1 Medical Village Dr, Edgewood, KY 41017-3403 | 2013-05-21 |
| 1992051395 | Deema Alkapalan | Pathology | 1 Medical Village Drive, Edgewood, KY 41017 | 2012-08-03 |
| 1346321478 | Mohammad M Yousef | Pathology | 1 Medical Village Dr, St Elizabeth Healthcare, Edgewood, KY 41017-3403 | 2006-10-17 |
| 1285725739 | Donn R Burns | Pathology | 1 Medical Village Dr, Edgewood, KY 41017-3403 | 2006-09-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801397005 | Lourente Bacus Tigas | Pathology | 330 Quail Ct, Russell, KY 41169-1575 | 2018-02-22 |
| 1275064743 | Treeva Jassim | Pathology | 800 Rose St Ste Ms -117, Lexington, KY 40536 | 2017-03-25 |
| 1265889372 | Alfred Bennett Jenson | Pathology | 2307 River Road, Suite 101, Louisville, KY 40206-5000 | 2016-05-18 |
| 1184983819 | Jessica Howard | Pathology | 3408 Squire Oak Dr, Lexington, KY 40515-1338 | 2012-05-15 |
| 1073871802 | Zhan Ye | Pathology | Department of Pathology 800 Rose St, Ms117, Lexington, KY 40536-0298 | 2012-04-30 |
| 1568720498 | Beth Ellen Frost | Pathology | Hq101 University of Kentucky, 800 Rose Street, Lexington, KY 40536-0288 | 2012-04-28 |
| 1104104801 | Lawrence Harold Boram | Pathology | 1918 Charbdin Pl, Louisville, KY 40207-1678 | 2011-07-28 |
| 1639482748 | Lauren Lippincott | Pathology | 10511 La Grange Rd, Louisville, KY 40223-1277 | 2010-07-17 |
| 1447447131 | Alka Uppal Khanna | Pathology | 3900 Southern Hills Dr, Ashland, KY 41102-7402 | 2007-09-26 |
| 1215132550 | Elena Samoilova | Pathology | Uk Department of Pathology 800 Rose St, Ms147, Lexington, KY 40536-0298 | 2007-06-18 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on JACKSON PEMBERTON.
| 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.