STACEY JACKSON (NPI# 1508301292) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508301292 |
| Entity Type | Individual |
| Full Name | STACEY JACKSON |
| Practice Address |
1015 S Broadway Suite 18 Minot ND 58701-4667 |
| Practice Telephone | 7018578500 |
| Practice Fax Number | 7018578555 |
| Mailing Telephone | 7018578500 |
| Mailing Fax Number | 7018578555 |
| Enumeration Date | 2017-01-04 |
| Last Update Date | 2017-01-04 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 163W00000X | Registered Nurse | R38052 | ND | Nursing Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588189310 | Stacey Marie Jackson | Psychologist | 11 Nealy Blvd, Hampton, VA 23665 | 2017-08-14 |
| 1134645674 | Stacey Jackson | Nurse Practitioner | 1604 Hospital Pkwy Ste 100, Bedford, TX 76022-5913 | 2017-08-16 |
| 1669828224 | Stacey Renee Jackson | Nurse Practitioner | 906 W Randol Mill Rd, Arlington, TX 76012-2510 | 2016-05-12 |
| 1497142459 | Stacey Ann Jackson | Nurse Practitioner | 1010 Central Avenue, Suite 2, Billings, MT 59102 | 2015-04-16 |
| 1760807234 | Stacey Renea Jackson | Counselor | 619 N Main St, Muskogee, OK 74401-4431 | 2014-02-20 |
| 1477849826 | Stacey Jo Jackson | Specialist | 17 S Central Ave, Idabel, OK 74745-4625 | 2011-06-23 |
| 1790926905 | Stacey L. Jackson | Counselor | 191 Memorial Dr, Pacolet, SC 29372-2255 | 2009-03-18 |
| 1578722278 | Stacey Marie Jackson | Physical Therapy Assistant | 4680 Cordata Pkwy, Bellingham, WA 98226-8038 | 2008-06-06 |
| 1659562692 | Stacey Lajune Jackson | Psychologist | 110 Eagles Walk, Ste. 100, Stockbridge, GA 30281-7204 | 2007-08-06 |
| 1457470726 | Stacey A Jackson | Pharmacist | 3301 Gordon Dr, Sioux City, IA 51105-3708 | 2007-03-28 |
| Street Address |
1015 S BROADWAY SUITE 18 |
| City | MINOT |
| State | ND |
| Zip Code | 58701-4667 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548200892 | Tim Scott Carlson | Pharmacist | 1015 S Broadway, Ste. #3, Minot, ND 58701-4667 | 2006-06-07 |
| 1831748151 | Elizabeth Ann Vibeto | Registered Nurse | 1015 S Broadway, Minot, ND 58701-4667 | 2019-09-09 |
| 1538693973 | Morgan Bright | Case Manager/Care Coordinator | 1015 S Broadway, Suite 18, Minot, ND 58701-4667 | 2017-04-12 |
| 1932631280 | Ness Family Dentistry, LLC | Clinic/Center | 1015 S Broadway, Suite 20, Minot, ND 58701-4667 | 2017-03-28 |
| 1679004899 | Onyinye Okoye-epundu | Registered Nurse | 1015 S Broadway, Suite 18, Minot, ND 58701-4667 | 2017-03-21 |
| 1568906949 | Kimberly Luster | Registered Nurse | 1015 S Broadway, Suite 18, Minot, ND 58701-4667 | 2016-12-05 |
| 1992248819 | Emmanuel Toquee | Case Manager/Care Coordinator | 1015 S Broadway, Suite 18, Minot, ND 58701-4667 | 2016-11-25 |
| 1366992661 | Shari Pister | Case Manager/Care Coordinator | 1015 S Broadway, Suite 18, Minot, ND 58701-4667 | 2016-10-11 |
| 1770032112 | Janelle Mellor | Case Manager/Care Coordinator | 1015 S Broadway, Suite 18, Minot, ND 58701-4667 | 2016-09-27 |
| 1235688672 | Dessa Krebsbach | Case Manager/Care Coordinator | 1015 S Broadway, Suite 18, Minot, ND 58701-4667 | 2016-09-27 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538767926 | Minot Commission On Aging, Inc | In Home Supportive Care | 21 1st Avenue Se, Minot, ND 58701 | 2020-10-16 |
| 1780207647 | Growing Together Inc | Counselor | 515 19 Ave Sw, Minot, ND 58701 | 2020-05-26 |
| 1144867847 | Sarah Howard | Registered Nurse | 1015 South Broadway, Ste. 2, Minot, ND 58701 | 2019-12-02 |
| 1962973453 | Julia Irene Lakoduk | Speech-Language Pathologist | Bell Elementary, 5901 Us-52, Minot, ND 58701 | 2018-12-10 |
| 1073000469 | Goodman Addiction Services | Counselor | 1809 South Broadway Suite S., Minot, ND 58701 | 2018-04-20 |
| 1811405988 | Mackenzie J Jones Pllc | Chiropractor | 1407 S Broadway Ste 123, Minot, ND 58701 | 2018-01-11 |
| 1265957617 | Cassandra Czerwonka | Behavioral Analyst | 1408 20th Ave Sw, Suite 7, Minot, ND 58701 | 2017-08-07 |
| 1689197493 | Rem North Dakota | Intermediate Care Facility, Mentally Retarded | 1905 2nd Street Se, Suite 1a, Minot, ND 58701 | 2017-07-24 |
| 1558890236 | Timothy J Corrigan | Chiropractor | 1418 S Broadway Ste C, Minot, ND 58701 | 2017-06-07 |
| 1265826036 | Premier Physical Therapy of North Dakota Pllc | Physical Therapist | 1715 South Broadway, Minot, ND 58701 | 2015-03-19 |
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| Taxonomy Code | 163W00000X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| (1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive either a diploma from a hospital program, an associate degree in nursing (A.D.N.) or a Bachelor of Science degree in nursing (B.S.N.), who is licensed or certified by the state, and is practicing within the scope of that license or certification. R.N.’s assist patient in recovering and maintaining their physical or mental health. They assist physicians during treatments and examinations and administer medications. (2) A provider who is trained and educated in a formal nursing education program at an accredited school of nursing, passes a national certification examination, and is licensed by the state to practice nursing. The individual provides nursing services to patients or clients in areas such as health promotion, disease prevention, acute and chronic care and restoration and maintenance of health across the life span. |
| Notes: Sources: (2) American Nurses Association, American Nurses Credentialing Center, 1996 Certification Catalogue, and Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265077861 | Kayla Mcleod | Registered Nurse | 1017 S Broadway Ste 18, Minot, ND 58701-4659 | 2019-11-07 |
| 1235409764 | Susan Gay Collins | Registered Nurse | 1503 5th Ave Nw, Minot, ND 58703-1902 | 2011-12-30 |
| 1588896724 | Mary Lee Anderson | Registered Nurse | 2815 Burdick Expy E, Minot, ND 58701-5204 | 2009-08-21 |
| 1649215070 | Vickie K Weathers | Registered Nurse | 307 5th Ave Se, Suite 502, Minot, ND 58701-4784 | 2006-06-19 |
| 1851923288 | Shianne M Evans | Registered Nurse | 1015 S Broadway Ste 18, Minot, ND 58701-4667 | 2020-02-04 |
| 1831748151 | Elizabeth Ann Vibeto | Registered Nurse | 1015 S Broadway, Minot, ND 58701-4667 | 2019-09-09 |
| 1770132441 | Kristina Myers | Registered Nurse | 1015 S Broadway Ste 3, Minot, ND 58701-4667 | 2019-09-05 |
| 1679004899 | Onyinye Okoye-epundu | Registered Nurse | 1015 S Broadway, Suite 18, Minot, ND 58701-4667 | 2017-03-21 |
| 1568906949 | Kimberly Luster | Registered Nurse | 1015 S Broadway, Suite 18, Minot, ND 58701-4667 | 2016-12-05 |
| 1669858874 | Deidre Fretland | Registered Nurse | 1015 S Broadway, Suite 18, Minot, ND 58701-4667 | 2015-08-11 |
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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.