AMANDA JACKSON (NPI# 1376041202) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376041202 |
| Entity Type | Individual |
| Full Name | AMANDA JACKSON |
| Practice Address |
205 S Jt Stites Sallisaw OK 74955-9301 |
| Mailing Address |
210 N Jt Stites Sallisaw OK 74955-9301 |
| Practice Telephone | 9187757787 |
| Practice Fax Number | 9187750328 |
| Mailing Telephone | 9187757787 |
| Mailing Fax Number | 9187750328 |
| Enumeration Date | 2018-01-25 |
| Last Update Date | 2018-01-25 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669008397 | Amanda Jackson | Pharmacist | 1418a W Main St Ste A, Lebanon, TN 37087-3114 | 2020-03-13 |
| 1730692765 | Amanda Lyn Jackson | Occupational Therapist | 2222 S Rockport Rd, Boonville, IN 47601-7926 | 2017-11-13 |
| 1982143467 | Amanda Jackson | Occupational Therapist | 5305 Reserve Dr Ne, Brookhaven, GA 30319-5924 | 2017-02-17 |
| 1528309473 | Amanda Nicole Jackson | Licensed Practical Nurse | 923 Cottage Ave, Miamisburg, OH 45342-1805 | 2013-03-01 |
| 1013254887 | Amanda Meister Jackson | Pharmacist | 10358 Riverside Dr Ste 140, Palm Beach Gardens, FL 33410-4203 | 2013-01-13 |
| 1285905240 | Amanda Jackson | Occupational Therapist | 1760 Turning Leaf Trl, Haughton, LA 71037-9531 | 2012-01-23 |
| 1245368661 | Amanda L Jackson | Physical Therapist | 17 Carlton Rd, Hutchinson, KS 67502-4423 | 2007-02-28 |
| 1861452112 | Amanda Elizabeth Jackson | Occupational Therapist | 121 Cox St, Benton, AR 72015-4611 | 2006-03-23 |
| 1437763638 | Amanda Jackson | Pharmacist | 7301 Theodore Dawes Rd, Theodore, AL 36582-4029 | 2020-09-04 |
| 1205460045 | Amanda Jackson | Registered Nurse | 940 W Mount Vernon St Ste 220, Nixa, MO 65714-9613 | 2020-03-02 |
| Street Address |
205 S JT STITES |
| City | SALLISAW |
| State | OK |
| Zip Code | 74955-9301 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760785919 | Ricky Walters | Case Manager/Care Coordinator | 205 S Jt Stites, Sallisaw, OK 74955 | 2010-12-09 |
| 1467836627 | Latosha Bowling | Counselor | 205 S Jt Stites, Sallisaw, OK 74955-9301 | 2015-07-16 |
| 1326319062 | Lester Tate | Counselor | 205 S Jt Stites, Sallisaw, OK 74955 | 2012-01-25 |
| 1053696138 | Michelle Shafer | Counselor | 205 S Jt Stites, Sallisaw, OK 74955 | 2011-10-20 |
| 1972887370 | John Tautfest | Counselor | 205 S Jt Stites, Sallisaw, OK 74955 | 2011-10-04 |
| 1992088868 | Jessica Oliver | Counselor | 205 S Jt Stites, Sallisaw, OK 74955 | 2011-09-27 |
| 1427357516 | Nancy Bigheart | Counselor | 205 S Jt Stites, Sallisaw, OK 74955 | 2011-03-15 |
| 1760789937 | Shellie Poindexter | Specialist | 205 S Jt Stites, Sallisaw, OK 74955 | 2011-02-23 |
| 1679878326 | Kristie Dawn Bradley | Case Manager/Care Coordinator | 205 S Jt Stites, Sallisaw, OK 74955 | 2011-01-11 |
| 1891098463 | John Hembree | Case Manager/Care Coordinator | 205 S Jt Stites, Sallisaw, OK 74955 | 2010-12-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063057297 | Audrey A. Martin | Technician | 463508 East 1044 Road, Sallisaw, OK 74955 | 2019-11-12 |
| 1013472356 | Christopher Alan Bush | Registered Nurse | 301 Jt Stites, Sallisaw, OK 74955 | 2019-01-31 |
| 1174098941 | Sequoyah County Drug Company Pllc | Pharmacy | 1632 S Kerr Blvd, Sallisaw, OK 74955 | 2018-10-09 |
| 1720570609 | Stephanie Choate | Registered Nurse | 2703 E Phillips Ave, Sallisaw, OK 74955 | 2018-06-05 |
| 1972964666 | Sallisaw Family Medicine, L.L.C. | Family Medicine | 104 South Oak St, Sallisaw, OK 74955 | 2016-03-09 |
| 1407258544 | Mika Goff | Counselor | 301 So. Jt Stites, Sallisaw, OK 74955 | 2014-09-19 |
| 1013348200 | Alton Matlock | Counselor | 2101 Winter Park Drive, Apt/suite, Sallisaw, OK 74955 | 2013-12-12 |
| 1881931509 | Wildhorse Family Practice & Urgent Care | Clinic/Center | 1024 W Cherokee, Sallisaw, OK 74955 | 2013-01-15 |
| 1083966576 | Kayla Plank | Counselor | 204 E Choctaw, Sallisaw, OK 74955 | 2012-10-08 |
| 1427307503 | Brandi Jean Henry | Counselor | 205 S. J.t. Stites, Sallisaw, OK 74955 | 2012-09-05 |
| Find all providers in zip 74955 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093230203 | Taylor Howell | Peer Specialist | 1108 N Wheeler Ave, Sallisaw, OK 74955-2227 | 2017-08-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659972537 | Tamra Lynn Cunningham | Peer Specialist | 764 Sherwin Ave, Ponca City, OK 74604-6112 | 2020-11-05 |
| 1699375691 | Martha Isabel Zapata | Peer Specialist | 5740 E 72nd Ct, Tulsa, OK 74136-7202 | 2020-10-28 |
| 1376143883 | Tina Marie Lopez | Peer Specialist | 933 N Oak St, Ponca City, OK 74601-3218 | 2020-10-26 |
| 1518566264 | Vincent Oaks Cox | Peer Specialist | 3585 S 439, Pryor, OK 74361-9346 | 2020-10-23 |
| 1558960146 | Sarah Elizabeth Walters | Peer Specialist | 2139 W Jasper St Apt B1, Broken Arrow, OK 74011-8028 | 2020-10-23 |
| 1861091548 | Ryan Vanmeter | Peer Specialist | 1965 Ladera Ln, Edmond, OK 73034-9787 | 2020-10-22 |
| 1255930038 | Brandon Loyd Hopkins | Peer Specialist | 446 S Scraper St, Vinita, OK 74301-4250 | 2020-10-22 |
| 1225637366 | Crystal Dawn Adams | Peer Specialist | 200 N Sante Fe Ave, Bartlesville, OK 74003 | 2020-10-20 |
| 1194324491 | Judith Anne Young | Peer Specialist | 3934 Se 27th St, Del City, OK 73115-2620 | 2020-10-19 |
| 1407455892 | Kristen Michelle Stock | Peer Specialist | 804 N Dryden Cir, Stillwater, OK 74075-7108 | 2020-10-18 |
| 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.