MR. KEVIN JACKSON (NPI# 1376838300) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376838300 |
| Entity Type | Individual |
| Full Name | MR. KEVIN JACKSON |
| Credential | LCPC |
| Practice Address |
15108 Doveheart Ln Bowie MD 20721-3054 |
| Practice Telephone | 2404613008 |
| Mailing Telephone | 2404613008 |
| Enumeration Date | 2011-06-17 |
| Last Update Date | 2011-06-17 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
LC4018 | MD | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114456498 | Kevin Thomas Jackson | Counselor | 310 S 49th W Ave, Tulsa, OK 74127 | 2017-06-08 |
| 1164845400 | Kevin Jackson Sr. | Counselor | 621 E Carnagie Dr # 210 San Bernardino Ca 92415, San Bernardino, CA 92415-3919 | 2014-01-22 |
| 1932545449 | Kevin D Jackson | Behavioral Analyst | 4060 Old Plantation Loop, Tallahassee, FL 32311-1306 | 2013-05-13 |
| 1174867634 | Kevin D Jackson | Dentist | 8101 Hinson Farm Rd Ste 216, Alexandria, VA 22306-3406 | 2012-11-21 |
| 1366724270 | Kevin R Jackson | Health Educator | 19752 Snowden St, Detroit, MI 48235-1180 | 2011-09-16 |
| 1881724607 | Kevin Carl Jackson | Optometrist | 7828 Eastern Ave Nw, Washington, DC 20012 | 2007-03-07 |
| 1144291907 | Kevin T Jackson | Family Medicine | 1420 Highway 62 65 N, Harrison, AR 72601-1959 | 2006-01-30 |
| 1316938517 | Kevin Lee Jackson | Internal Medicine | 2430 Village Professional Dr, Opelika, AL 36801-2378 | 2005-11-04 |
| 1588654115 | Kevin Michael Jackson | Optometrist | 39-06 Kramer Pl, Fair Lawn, NJ 07410-5311 | 2005-10-25 |
| 1225032782 | Kevin Gordon Jackson | Family Medicine | 8111 E Thomas Rd, Ste 124, Scottsdale, AZ 85251-5844 | 2005-06-11 |
| Street Address |
15108 DOVEHEART LN |
| City | BOWIE |
| State | MD |
| Zip Code | 20721-3054 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114309721 | Urban Interventional Strategies | Community/Behavioral Health | 15108 Doveheart Ln, Bowie, MD 20721-3054 | 2015-06-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124683768 | Lucie Bakop | Nurse Practitioner | 1217 Kingsbury Drive, Bowie, MD 20721 | 2019-05-09 |
| 1699245258 | Rita Nkilo Chofong | Home Health Aide | 1810 Sahara Lane, Bowie, MD 20721 | 2018-11-27 |
| 1215416136 | Mbah Charles | Home Health Aide | 3705 Clayton Dr, Bowie, MD 20721 | 2018-08-10 |
| 1730678061 | Isabell Home Care Assisted Living LLC | Assisted Living Facility | 11609 Candor Drive, Bowie, MD 20721 | 2018-05-02 |
| 1619486974 | Orthatech Inc | Durable Medical Equipment & Medical Supplies | 12138 Central Ave #777, Suite 961, Mitchelville, MD 20721 | 2017-09-29 |
| 1780103994 | Rosefidelis Omnicare, LLC | Registered Nurse | 3815 Alta Vista Drive, Bowie, MD 20721 | 2017-09-19 |
| 1013436070 | Adisatu Renner | Counselor | 4202 Taverngreen Lane, Bowie, MD 20721 | 2017-09-11 |
| 1730607375 | Hope Inyamah Coston | Student in an Organized Health Care Education/Training Program | 12158 Central Avenue, Mitchellville, MD 20721 | 2017-09-05 |
| 1982121463 | Awal A Aziz | Specialist/Technologist, Other | 14303 Duncannon Court, Bowie, MD 20721 | 2017-08-25 |
| 1851841555 | Emmanuel K Tanyi | Home Health Aide | 10971 Spyglass Hill, Bowie, MD 20721 | 2016-10-06 |
| Find all providers in zip 20721 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346869484 | Autism Community Enterprises, Inc | Counselor | 16604 Peach St, Bowie, MD 20716-3526 | 2020-04-09 |
| 1578101523 | Michelle Durham | Counselor | 12504 Keynote Ln, Bowie, MD 20715-2746 | 2019-12-19 |
| 1275184301 | Harold Raul Dawkins | Counselor | 14632 London Ln, Bowie, MD 20715-2572 | 2019-09-20 |
| 1679128557 | Brian Bailey | Counselor | 15201 Jenkins Ridge Rd, Bowie, MD 20721-7256 | 2019-08-07 |
| 1417413253 | Demitri Kornegay | Counselor | 12805 Vicar Woods Ln, Bowie, MD 20720-4770 | 2019-02-18 |
| 1336622059 | Amy Winiecki | Counselor | 4201 Northview Dr # 104, Bowie, MD 20716-2604 | 2018-09-09 |
| 1396225264 | Patricia Morgan Cooper | Counselor | 2825 Bosworth Ln, Bowie, MD 20715-2402 | 2018-08-20 |
| 1538652227 | Fabienne Bonaventure | Counselor | 13014 5th St, Bowie, MD 20720 | 2018-06-07 |
| 1528563376 | Cynthia Hunter | Counselor | 5429 Lakeford Ln, Bowie, MD 20720-4855 | 2018-03-26 |
| 1679075576 | Marcella Louise Debose | Counselor | 15957 Alameda Dr, Bowie, MD 20716-1384 | 2018-03-06 |
| Find all providers in BOWIE | ||||
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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.