MICHELLE EBONG JACKSON (NPI# 1053872036) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053872036 |
| Entity Type | Individual |
| Full Name | MICHELLE EBONG JACKSON |
| Credential | APRN |
| Practice Address |
3525 Fm 2484 Salado TX 76571-6169 |
| Mailing Address |
Po Box 844658 Dallas TX 75284-4658 |
| Practice Telephone | 2549477500 |
| Practice Fax Number | 2549477521 |
| Mailing Telephone | 2547242111 |
| Enumeration Date | 2019-03-30 |
| Last Update Date | 2020-05-11 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
AP141208 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 4504 Teal Dr, Killeen, TX 765423704 | 2817777144 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104434067 | Michelle Jackson | Behavior Technician | 6961 Rooks Ct Apt 305, Frederick, MD 21703-2781 | 2020-07-16 |
| 1790347722 | Michelle Lynn Jackson | Family Medicine | 456 Circle Dr, Kewanee, IL 61443-3622 | 2019-06-29 |
| 1396301487 | Michelle Jackson | Technician | 14000 Castle Blvd Apt 703, Silver Spring, MD 20904-4640 | 2019-05-14 |
| 1184196685 | Michelle Maria Jackson | Health Educator | 220 E 89th St, Brooklyn, NY 11236-1418 | 2018-12-20 |
| 1396253258 | Michelle Laray Jackson | Counselor | 3765 Carisbrook Dr, North Las Vegas, NV 89081-6631 | 2018-01-12 |
| 1427509173 | Michelle Jackson | Behavioral Analyst | 115 Franklin St Ne Apt H21, Washington, DC 20002-1091 | 2016-10-18 |
| 1891193678 | Michelle Jackson | Occupational Therapy Assistant | 12611 Hickman Pl, Denver, CO 80239-6204 | 2014-12-10 |
| 1215338330 | Michelle Jackson | Nurse Practitioner | 115 Fields St # De, Mooresville, IN 46158-1492 | 2014-09-08 |
| 1699058008 | Michelle A Jackson | Occupational Therapist | 6045 Ashford Ln, Unit 102, Naples, FL 34110-2416 | 2011-09-21 |
| 1285923185 | Michelle Ann Jackson | Rehabilitation Practitioner | 7124 Diving Petrels Pl, 7124 Diving Petrels Pl, North Las Vegas, NV 89084-2353 | 2011-03-31 |
| Street Address |
3525 FM 2484 |
| City | SALADO |
| State | TX |
| Zip Code | 76571-6169 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821059080 | William F Ligon Jr. | Family Medicine | 3525 Fm 2484, Salado, TX 76571-6169 | 2006-03-29 |
| 1295262491 | Tyler Smith | Family Medicine | 3525 Fm 2484, Salado, TX 76571-6169 | 2017-05-18 |
| 1932519600 | Michael Brazos Fielder | Family Medicine | 3525 Fm 2484, Salado, TX 76571-6169 | 2014-05-05 |
| 1346667631 | Bonnie Carr | Pharmacist | 3525 Fm 2484, Salado, TX 76571-6169 | 2014-03-25 |
| 1366695579 | Baylor Health Enterprises Lp | Pharmacy | 3525 Fm 2484, Suite B, Salado, TX 76571-6169 | 2008-10-31 |
| 1770549172 | Cheryl Warren | Family Medicine | 3525 Fm 2484, Salado, TX 76571-6169 | 2006-04-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770199101 | Mavon Oversight Pllc | Emergency Medicine | 340 Van Bibber, Salado, TX 76571 | 2020-09-21 |
| 1386798742 | Crdamc | Military Hospital | 1162 Shady Oaks Dr., Salado, TX 76571 | 2007-01-23 |
| 1710044250 | Douglas Barton Willingham | Dentist | 2 N. Main St., Salado, TX 76571 | 2007-01-03 |
| 1922112887 | Sheila Ann Tauferner | Nurse Practitioner | 1607 Indian Trail, Salado, TX 76571 | 2006-08-18 |
| 1770796534 | Sam W Teas | Dentist | 213 Mill Creek Dr, Suite 105, Salado, TX 76571 | 2007-05-08 |
| 1902950876 | Emily Elise Sigler | Genetic Counselor, MS | Po Box 144, Salado, TX 76571-0144 | 2007-01-22 |
| 1639189210 | Alice Harriott Cooper | Physical Therapist | 690 Rose Ln, Salado, TX 76571-0679 | 2006-08-08 |
| 1821240284 | Carol Meyer Willingham | Marriage & Family Therapist | 2 N Main St At Thomas Arnold Road, Salado, TX 76571-0767 | 2008-10-16 |
| 1194369983 | Lori K Underwood | Home Health Aide | 3110 Saint Luke St, Salado, TX 76571-2112 | 2019-11-05 |
| 1689078909 | Kathleen T Darnell | Dental Hygienist | 2200 Indian Trl, Salado, TX 76571-4917 | 2014-10-15 |
| Find all providers in zip 76571 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487255162 | Shaida Rahmatinick | Nurse Practitioner | 1515 W 22nd St, Houston, TX 77008-1501 | 2020-11-08 |
| 1891396586 | Stacey Lynne Ready | Nurse Practitioner | 200 Uptmore Rd, West, TX 76691-2339 | 2020-11-08 |
| 1992306609 | Jillian Mcclintock | Nurse Practitioner | 2506 Graystone Ln, Corinth, TX 76210-1607 | 2020-11-08 |
| 1851992515 | Stacie A Gregg | Nurse Practitioner | 1229 Johnny Ln, San Angelo, TX 76905-2331 | 2020-11-07 |
| 1285235929 | Activate Family Health, Pllc | Nurse Practitioner | 203 E Davis St Ste F-1026, Conroe, TX 77301-3159 | 2020-11-07 |
| 1629679782 | Kristen Aili Johnson | Nurse Practitioner | 3850 Fm 18, Abilene, TX 79602-2004 | 2020-11-05 |
| 1376144303 | Stephanie Renee Knight | Nurse Practitioner | 4326 Egret Dr, Seabrook, TX 77586-2557 | 2020-11-05 |
| 1457952319 | Olufunke Oyindamola Oshoba | Nurse Practitioner | 200 Odyssey Ln, Mansfield, TX 76063-3438 | 2020-11-05 |
| 1518568419 | Ian Mardis | Nurse Practitioner | 12528 Tierra Encino Dr, El Paso, TX 79938-4525 | 2020-11-05 |
| 1851992994 | Angela Davis | Nurse Practitioner | 9523 Scanlan Heights Ln, Missouri City, TX 77459-5503 | 2020-11-05 |
| Find all providers with the same taxonomy | ||||
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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.