DR. JOHN RONALD JACKSON (NPI# 1114922911) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114922911 |
| Entity Type | Individual |
| Full Name | DR. JOHN RONALD JACKSON |
| Credential | M.D. |
| Practice Address |
20 Medical Village Dr Ste 302 Edgewood KY 41017-5402 |
| Mailing Address |
2060 Reading Rd Suite 150 Cincinnati OH 45202-1454 |
| Practice Telephone | 8593412510 |
| Practice Fax Number | 8595782004 |
| Mailing Telephone | 5137213200 |
| Mailing Fax Number | 5136393186 |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2015-07-31 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207V00000X | Obstetrics & Gynecology | 35. 073600 | OH | Allopathic & Osteopathic Physicians |
| Y | 207V00000X | Obstetrics & Gynecology | 34447 | KY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 7100093740 | 05 | |
| OH | 3003565 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801439799 | John Archie Jackson Jr. | Counselor | 209 Martin Luther King Dr, Elizabethtown, NC 28337 | 2019-10-23 |
| 1063073310 | John Jackson | Speech-Language Pathologist | 2143 Mohawk Trl, Maitland, FL 32751-3950 | 2019-06-27 |
| 1992202832 | John Jackson | Physical Therapy Assistant | 209 Lake St, Chittenango, NY 13037-1518 | 2018-04-08 |
| 1063911105 | John Martin Jackson | Physical Therapy Assistant | 11118 Lantern Way, North Chesterfield, VA 23236-3575 | 2018-02-05 |
| 1184164493 | John Jackson | Emergency Medical Technician, Paramedic | 137 S Newport Ave, Newport, WA 99156-1942 | 2017-03-06 |
| 1508236837 | John Willard Jackson | Anesthesiology | 7857 Caruth Ct, Dallas, TX 75225-8133 | 2015-09-29 |
| 1043572035 | John Ferndale Jackson | Behavioral Analyst | 931 Azure Heights Place, Las Vegas, NV 89110 | 2012-06-14 |
| 1679830558 | John Michael Jackson | Pharmacist | 1000 Castlebay, Cincinnati, OH 45245-4910 | 2012-04-18 |
| 1013043553 | John Phillip Jackson | Occupational Therapist | 7810 Avenue U Apt B, Lubbock, TX 79423-2430 | 2007-02-26 |
| 1275673451 | John W Jackson | Pharmacist | 1667 Bellemeade Dr, Altoona, PA 16602-7402 | 2007-02-07 |
| Street Address |
20 MEDICAL VILLAGE DR STE 302 |
| City | EDGEWOOD |
| State | KY |
| Zip Code | 41017-5402 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841295243 | Paul Allen Jacobs | Obstetrics & Gynecology | 20 Medical Village Dr, Ste 302, Edgewood, KY 41017-5402 | 2005-06-14 |
| 1043821085 | David Thomas Tackett | Nurse Practitioner | 20 Medical Village Dr, Edgewood, KY 41017-5401 | 2020-08-13 |
| 1245866888 | Annalee Fitzpatrick | Nurse Practitioner | 20 Medical Village Dr, Edgewood, KY 41017-5401 | 2020-03-16 |
| 1972137313 | Thomas Gravely | Pharmacist | 20 Medical Village Dr, Edgewood, KY 41017-5401 | 2020-02-25 |
| 1205487071 | Amanda M Hofmeyer | Nurse Practitioner | 20 Medical Village Dr, Edgewood, KY 41017-5401 | 2019-09-24 |
| 1528535804 | Heidi Ann Ducker | Nurse Practitioner | 20 Medical Village Dr, Edgewood, KY 41017-5401 | 2018-10-25 |
| 1316433014 | Tara Nagaraj | Pharmacist | 20 Medical Village Dr, Edgewood, KY 41017 | 2018-07-05 |
| 1033628268 | Jennifer Teresa Sprague | Physician Assistant | 20 Medical Village Dr, Edgewood, KY 41017-5401 | 2017-09-20 |
| 1235658857 | Eric Joseph Faris | Nurse Practitioner | 20 Medical Village Dr, Edgewood, KY 41017 | 2017-09-14 |
| 1356876940 | Jennifer Vaden | Registered Nurse | 20 Medical Village Dr, Suite 301, Edgewood, KY 41017-5401 | 2017-04-20 |
| 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 | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851701452 | Megan O'conner Schneider | Obstetrics & Gynecology | 20 Medical Village Dr Ste 302, Edgewood, KY 41017 | 2014-05-05 |
| 1538467196 | Trihealth G LLC | Obstetrics & Gynecology | 1 Medical Village Dr Fl 3, Edgewood, KY 41017-3403 | 2011-03-07 |
| 1043537723 | Charles Stephens, M.d. | Obstetrics & Gynecology | 3106 Hudnall Ln, Edgewood, KY 41017-2321 | 2010-04-21 |
| 1922043561 | Sanjeevani Takemalker Kulkarni | Obstetrics & Gynecology | 1020 Edgewood Rd, Edgewood, MD 21040 | 2006-06-18 |
| 1841295243 | Paul Allen Jacobs | Obstetrics & Gynecology | 20 Medical Village Dr, Ste 302, Edgewood, KY 41017-5402 | 2005-06-14 |
| 1043213028 | Vincent Thomas Bilotta | Obstetrics & Gynecology | 20 Medical Village Drive, Suite 302, Edgewood, KY 41017-5402 | 2005-05-24 |
| 1639559339 | Brittny Schadler | Obstetrics & Gynecology | 20 Medical Village Dr Ste 302, Edgewood, KY 41017-5402 | 2015-06-08 |
| 1467867044 | Lifebridge Community Physicians, Inc | Obstetrics & Gynecology | 1401 Pulaski Hwy, Suite M, Edgewood, MD 21040-1398 | 2014-06-23 |
| 1689922619 | Charles Oliver Stephens | Obstetrics & Gynecology | 3106 Hudnall Ln, Edgewood, KY 41017 | 2012-08-23 |
| 1942579073 | Harford County Health Department | Obstetrics & Gynecology | 1321 Woodbridge Station Way, Edgewood, MD 21040-3830 | 2011-12-19 |
| Find all providers in EDGEWOOD | ||||
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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.