DR. KELLY DONALD JACKSON (NPI# 1518982487) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518982487 |
| Entity Type | Individual |
| Full Name | DR. KELLY DONALD JACKSON |
| Credential | DDS |
| Practice Address |
3023 Eastland Blvd Ste 112 Clearwater FL 33761-4106 |
| Practice Telephone | 7277975161 |
| Practice Fax Number | 2779751217 |
| Mailing Telephone | 2779751617 |
| Mailing Fax Number | 2777975121 |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2020-08-25 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | 14202 | MI | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588036263 | Kelly Jackson | Social Worker | 2937 Ne 16th Ter, Gainesville, FL 32609-3234 | 2015-10-21 |
| 1477896876 | Kelly A Jackson | Occupational Therapist | 178 Manila Ave, Staten Island, NY 10306-5608 | 2013-04-03 |
| 1104986793 | Kelly A Jackson | Chiropractor | 190 North Main Street, Natick, MA 01760 | 2006-12-12 |
| 1689273310 | Kelly Jackson | Behavior Technician | 27777 Inkster Rd Ste 100, Farmington Hills, MI 48334-5312 | 2020-10-23 |
| 1629544655 | Kelly Colleen Jackson | Counselor | 811 Madison St, Everett, WA 98203-4543 | 2018-10-17 |
| 1619457926 | Kelly Jackson | Physician Assistant | 12300 Mccracken Rd, Garfield Heights, OH 44125-2975 | 2018-08-16 |
| 1760961833 | Kelly D Jackson | Licensed Practical Nurse | 602 W Semands St, Conroe, TX 77301-1867 | 2018-08-09 |
| 1841780178 | Kelly Amanda Jackson | Nurse Practitioner | 1700 Medical Center Pkwy, Murfreesboro, TN 37129-2245 | 2018-05-11 |
| 1033653431 | Kelly Jackson | Nurse Practitioner | 606 W Columbia St, San Augustine, TX 75972-1709 | 2016-12-05 |
| 1497108310 | Kelly Jackson | Massage Therapist | 1325 San Marco Blvd, Suite 102, Jacksonville, FL 32207-8568 | 2016-07-15 |
| Street Address |
3023 EASTLAND BLVD STE 112 |
| City | CLEARWATER |
| State | FL |
| Zip Code | 33761-4106 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770184210 | Sandra Shanice Campisi | Behavior Technician | 29228 Us-19 N, Clearwater, FL 33761 | 2020-11-02 |
| 1659838449 | Branden Kleehammer | Occupational Therapy Assistant | 6941 300th Ave N, Clearwater, FL 33761 | 2019-02-27 |
| 1063901403 | Sheleaha C Egly I | Behavior Technician | 29288 Us Highway 19 N, Clearwater, FL 33761 | 2018-05-01 |
| 1760979629 | Melissa Irene Valentine | Social Worker | 6997 300th Ave North, Clearwater, FL 33761 | 2018-04-17 |
| 1871011049 | Maria's Adult Day Care Center | Clinic/Center | 26224 Us Highway 19 N., Clearwater, FL 33761 | 2017-09-07 |
| 1962933739 | Robert Hudson | Occupational Therapist | 3463 Northridge Dr, Clearwater, FL 33761 | 2017-03-23 |
| 1366985582 | Brandon Chad Brown | Physician Assistant | 29277 Hwy 19 North, Clearwater, FL 33761 | 2016-11-19 |
| 1730575606 | Layne S Winker | Physician Assistant | 26812 Us 19 N # 19, Clearwater, FL 33761 | 2015-04-08 |
| 1407254907 | M Christina Memoli Od Pa | Optometrist | 27901 Us 19 N, Clearwater, FL 33761 | 2014-12-15 |
| 1952729774 | Gina Pietras Spohn | Dermatology | 3165 N Mcmullen Booth Rd Bldg B, Clearwater, FL 33761 | 2014-03-29 |
| Find all providers in zip 33761 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447723804 | Professional Dental Alliance of Clearwater, Pllc | Dentist | 2685 Ulmerton Rd Ste 103, Clearwater, FL 33762-3332 | 2019-01-09 |
| 1952876542 | Affordable Dentures & Implants - Clearwater, P.a. | Dentist | 26258 Us Highway 19 N, Clearwater, FL 33761-4506 | 2018-10-10 |
| 1376035865 | Evan Murell | Dentist | 2532 State Road 580 Ste F, Clearwater, FL 33761-2906 | 2018-05-31 |
| 1033631031 | Sophia Mazanitis | Dentist | 23680 Us 19 N, Clearwater, FL 33765-1571 | 2017-07-11 |
| 1043693542 | Erin Sharkey | Dentist | 15 Turner St Apt 4, Clearwater, FL 33756-5236 | 2015-07-01 |
| 1184050411 | Anthony Richard Cheslock | Dentist | 1831 Belcher Road North, 1-b, Clearwater, FL 33765 | 2013-09-18 |
| 1215371836 | Shoukry Soliman | Dentist | 2701 Park Dr Ste 7, Clearwater, FL 33763-1021 | 2013-04-25 |
| 1326301144 | Jessica D Keller | Dentist | 2532 S.r. 580, Suite 5, Clearwater, FL 33761-2906 | 2012-06-18 |
| 1073804886 | Eugene Ray Ledford | Dentist | 1601 South Highland Ave., Clearwater, FL 33756 | 2011-04-27 |
| 1902078553 | Nick V Faklis | Dentist | 251 Windward Passage, Suite H, Clearwater, FL 33767 | 2008-03-24 |
| Find all providers in CLEARWATER | ||||
| City | CLEARWATER |
| Zip Code | 33761 |
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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.