MR. KENNETH WAYNE JACKSON (NPI# 1972510352) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972510352 |
| Entity Type | Individual |
| Full Name | MR. KENNETH WAYNE JACKSON |
| Credential | APRN, BC |
| Practice Address |
1811 Memorial Dr Clarksville TN 37043-4604 |
| Mailing Address |
245 Hickory Hts Clarksville TN 37040-3935 |
| Practice Telephone | 9315523031 |
| Practice Fax Number | 9316479820 |
| Mailing Telephone | 9316451131 |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
APN6357 | TN | Physician Assistants & Advanced Practice Nursing Providers |
| 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 |
| 1487606943 | Kenneth Wade Jackson Jr. | Obstetrics & Gynecology | 22 Manningfield Dr, Fletcher, NC 28732-9457 | 2006-05-16 |
| 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 |
1811 MEMORIAL DR |
| City | CLARKSVILLE |
| State | TN |
| Zip Code | 37043-4604 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043630460 | Taylor Spine and Sports Rehabilitation Pllc | Acupuncturist | 1811 Memorial Dr, Clarksville, TN 37043-4604 | 2014-04-24 |
| 1124441522 | James Vincent Taylor | Chiropractor | 1811 Memorial Dr, Clarksville, TN 37043-4604 | 2014-01-22 |
| 1548538952 | Heather Hurt | Physical Therapist | 1811 Memorial Dr, Clarksville, TN 37043-4604 | 2011-12-13 |
| 1649582420 | Casey Jean Blackburn | Speech-Language Pathologist | 1811 Memorial Dr, Clarksville, TN 37043-4604 | 2010-07-08 |
| 1750526562 | Tracy Blankenship | Speech-Language Pathologist | 1811 Memorial Dr, Clarksville, TN 37043-4604 | 2008-12-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952958464 | Barbara Gallahan | Technician | 3992 Lakewood Dr., Clarksville, TN 37043 | 2019-08-20 |
| 1144874728 | Intricate Care | Registered Nurse | 2299 Raleigh Ct, Clarksville, TN 37043 | 2019-07-31 |
| 1740842145 | Caila Anne Wiblitzhouser Holm | Counselor | 755 Weatherly Drive, Clarksville, TN 37043 | 2019-07-05 |
| 1407416407 | Heartland Dental Care of Tennessee, PC | Dentist | 930 Highway 76, Clarksville, TN 37043 | 2019-06-20 |
| 1376021501 | Stephen Lawrence Rego | Case Manager/Care Coordinator | Cohen Military Family Clinic, 775 Weatherly Dr, Clarksville, TN 37043 | 2018-07-31 |
| 1366928095 | Kendra Lee | Social Worker | 775 Weatherly Dr., Clarksville, TN 37043 | 2018-07-16 |
| 1245742931 | Andrea L Edelstein | Dentist | 1818 Memorial Dr., Unit 47, Clarksville, TN 37043 | 2017-11-02 |
| 1043736119 | Megan Pritchett Landre | Behavior Technician | 990 South Ridge Trail, Clarksville, TN 37043 | 2017-08-20 |
| 1932624798 | Sandra Melissa Corral | Behavior Technician | 139e Old Trenton Rd, Suite B, Clarksville, TN 37043 | 2017-08-13 |
| 1700306032 | Sahiti Kandati | Dentist | 1777 Madison Ste Ste 100, Clarksville, TN 37043 | 2017-06-27 |
| Find all providers in zip 37043 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043810849 | Olushola Taiwo Adekoya | Nurse Practitioner | 6909 Crossfield Ct, Clarksville, MD 21029-1749 | 2020-10-29 |
| 1497367981 | Kinjal Bhatt | Nurse Practitioner | 5805 Wild Orange Gate, Clarksville, MD 21029-1657 | 2020-08-18 |
| 1568087625 | Holly A Woosley | Nurse Practitioner | 746 W Kenwood Ave, Clarksville, IN 47129-2545 | 2020-06-14 |
| 1881222461 | Michelle G Rowan | Nurse Practitioner | 13515 Highland Rd, Clarksville, MD 21029-1427 | 2020-03-30 |
| 1669026258 | Ashley M Hettinger | Nurse Practitioner | 1455 Cedar St Ste D, Clarksville, IN 47129-7700 | 2019-07-31 |
| 1093375040 | Scarlett Hancock | Nurse Practitioner | 116 Commerce St, Clarksville, TN 37040-3641 | 2019-06-20 |
| 1336702067 | Leslea Renae Streetman | Nurse Practitioner | 525 Rosewood Dr, Clarksville, TN 37043-5126 | 2019-04-18 |
| 1629556980 | Julie Mcintosh | Nurse Practitioner | 1690 Fort Campbell Blvd, Clarksville, TN 37042-7531 | 2018-07-30 |
| 1720576218 | Chelsey Meek | Nurse Practitioner | 4101 Lena Ct, Clarksville, TN 37043-7625 | 2018-04-30 |
| 1316440696 | Kayla Vanden Hull | Nurse Practitioner | 3147 Cross Ridge Dr, Clarksville, TN 37040-5799 | 2018-03-13 |
| Find all providers in CLARKSVILLE | ||||
| City | CLARKSVILLE |
| Zip Code | 37043 |
Please comment or provide details below to improve the information on MR. KENNETH WAYNE JACKSON.
| 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.