DR. MENDOZA'S PEDIATRIC AND ADOLSCENT (NPI# 1295908101) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295908101 |
| Entity Type | Organization |
| Organization Name | DR. MENDOZA'S PEDIATRIC AND ADOLSCENT |
| Practice Address |
424 Jett Dr Jackson KY 41339-9621 |
| Mailing Address |
Po Box 790 Jackson KY 41339-0790 |
| Practice Telephone | 6066934800 |
| Practice Fax Number | 6066934825 |
| Mailing Telephone | 6066934800 |
| Mailing Fax Number | 6066934825 |
| Enumeration Date | 2008-04-11 |
| Last Update Date | 2014-07-10 |
| Authorized Official Name | EDGAR ALLEN MENDOZA (OWNER) |
| Authorized Official Telephone | 6066934800 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
33465 | KY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 31000979 | 05 |
| Street Address |
424 JETT DR |
| City | JACKSON |
| State | KY |
| Zip Code | 41339-9621 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003815390 | George Edward Burnette | Family Medicine | 424 Jett Dr, Jackson, KY 41339-9621 | 2005-07-19 |
| 1912518978 | Jackson Hospital Corporation | Clinic/Center | 424 Jett Dr, Jackson, KY 41339-9621 | 2020-08-13 |
| 1083145866 | Rebecca Mae Holbrook-watkins | Nurse Practitioner | 424 Jett Dr, Jackson, KY 41339 | 2017-03-23 |
| 1295283448 | Kathryn Ann Morgan | Nurse Practitioner | 424 Jett Dr, Jackson, KY 41339-9621 | 2016-09-16 |
| 1164722807 | Jackson Physician Corp | Nurse Practitioner | 424 Jett Dr, Jackson, KY 41339-9621 | 2010-10-28 |
| 1992827927 | Kentucky River Physician Corporation | Clinic/Center | 424 Jett Dr, Jackson, KY 41339-9621 | 2007-04-03 |
| 1841234671 | Jackson Physician Corp | Clinic/Center | 424 Jett Dr, Jackson, KY 41339-9621 | 2006-06-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841890662 | Angela Shawn Bradley | Pharmacist | 1589 Ky Hwy 15 South, Jackson, KY 41339 | 2020-10-30 |
| 1871191734 | Ranita Greer | Pharmacist | 59 Ky-15 N, Jackson, KY 41339 | 2020-10-13 |
| 1336763135 | Jill Elaine Beattie Green | Occupational Therapist | 100 Ky-15, Jackson, KY 41339 | 2020-06-08 |
| 1023641446 | Andreanna Gibbs | Physical Therapy Assistant | 100 Hwy 15, Jackson, KY 41339 | 2020-02-13 |
| 1144797754 | Visionary Rehabilitation Services, LLC | Speech-Language Pathologist | 100 Kentucky Hwy 15 South, Suite 136, Jackson, KY 41339 | 2018-11-01 |
| 1477081206 | Trending Upwards | Counselor | 1754 Highway 15 N, Jackson, KY 41339 | 2017-05-24 |
| 1508225996 | Jessica Williams | Pharmacist | 842 Highway 15 N, Jackson, KY 41339 | 2016-02-15 |
| 1245637255 | Breathitt County Ambulance, Inc. | Ambulance | 440 Highway 1812 North, Jackson, KY 41339 | 2014-11-20 |
| 1265784045 | Jonathan Charles Morris | Physical Therapist | 695 Ky Hwy 15 N, Ste 3, Jackson, KY 41339 | 2012-10-04 |
| 1649539958 | Henry Price Sewell IIi IIi | Family Medicine | 170 Picnic Hill Rd, Jackson, KY 41339 | 2012-05-07 |
| Find all providers in zip 41339 | ||||
| Taxonomy Code | 2080A0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Adolescent Medicine |
| A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659366854 | Michelle J Gibson | Pediatrics | 5440 Watkins Dr, Suite B, Jackson, MS 39206-2034 | 2005-09-13 |
| 1205953809 | Upa Pllc Adolescent Med | Pediatrics | 2500 N State St, Jackson, MS 39216-4500 | 2007-03-26 |
| 1871566323 | David J Stone | Pediatrics | 100 Mission Blvd, Suite 2600, Jackson, CA 95642-2536 | 2006-02-07 |
| 1548259559 | Radha Inagandla Alur | Pediatrics | 2500 N State St, Jackson, MS 39216 | 2005-10-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154715159 | Gregory Tracy | Pediatrics | 3050 Harrodsburg Rd Ste 100, Lexington, KY 40503 | 2015-03-27 |
| 1497088090 | Henderson Pediatrics, Psc | Pediatrics | 1035 N Elm St, Henderson, KY 42420-2712 | 2009-09-14 |
| 1679773154 | Sheila M Guelda Md Pllc | Pediatrics | 2809 N Hurstbourne Pkwy, Suite 109, Louisville, KY 40223-1279 | 2007-07-23 |
| 1235296617 | Suzanne L Woods | Pediatrics | 301 C Middletown Park Place, Louisville, KY 40243 | 2007-01-03 |
| 1811062151 | Winit Chartisathian | Pediatrics | 73 Kingswood Dr, Campbellsville, KY 42718-9604 | 2006-11-22 |
| 1871694174 | Angelito L Samson | Pediatrics | 150 Frankfort Rd, Suite 101, Shelbyville, KY 40065-9433 | 2006-09-26 |
| 1558376392 | Robert J Tagher | Pediatrics | 7409 Us Highway 42, Florence, KY 41042-1905 | 2006-07-30 |
| 1710947817 | Paul J Janson | Pediatrics | 7370 Turfway Road, Suite 280, Florence, KY 41042 | 2006-03-24 |
| 1457331555 | Debra R. Bailey | Pediatrics | 419 Town Mountain Road, Suite 202, Pikeville, KY 41501-1633 | 2006-01-17 |
| 1700863230 | Dana J Distler | Pediatrics | 301 Middletown Park Pl, Suite C, Louisville, KY 40243-2515 | 2005-12-27 |
| 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.