SHANNON E JACKSON (NPI# 1558301168) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558301168 |
| Entity Type | Individual |
| Full Name | SHANNON E JACKSON |
| Credential | MD |
| Practice Address |
4805 Ne Glisan St Portland OR 97213-2933 |
| Mailing Address |
Po Box 3158 Portland OR 97208-3158 |
| Practice Telephone | 5032152393 |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2014-09-09 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | MD25874 | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 028116 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235761149 | Shannon M Jackson | In Home Supportive Care | 4028 Vira Rd, Stow, OH 44224-3637 | 2020-02-08 |
| 1124526280 | Shannon Jackson | Nurse Practitioner | 850 Independence Ave, Akron, OH 44310-2541 | 2018-01-24 |
| 1588182463 | Shannon Daneigh Jackson | Technician | 4660 Martin Luther King Jr Ave Sw Apt B406, Washington, DC 20032-4978 | 2017-08-31 |
| 1851842843 | Shannon Regina Jackson | Nurse Practitioner | 294 Cypress Lakes Dr., Slidell, LA 70458 | 2016-10-14 |
| 1598027393 | Shannon Jackson | Behavioral Analyst | 2325 Nw 115th St, Oklahoma City, OK 73120-7309 | 2012-06-08 |
| 1417281064 | Shannon Jackson | Psychologist | 150 North Main St, Echn Health Services, Manchester, CT 06040-4188 | 2009-09-30 |
| 1235766601 | Shannon Laura Jackson | Registered Nurse | 2301 Erwin Rd, Durham, NC 27705-4699 | 2020-03-25 |
| 1407411366 | Shannon Jackson | Physical Therapy Assistant | 730 Thimble Shoals Blvd Ste 130, Newport News, VA 23606-4562 | 2019-05-07 |
| 1558742395 | Shannon Marie Jackson | Counselor | 4990 Williams Ave, La Mesa, CA 91942-7409 | 2015-06-17 |
| 1811323645 | Shannon Denise Jackson | Nurse Practitioner | 2800 Dallas Pkwy, Suite 150, Plano, TX 75093-5993 | 2013-09-25 |
| Street Address |
4805 NE GLISAN ST |
| City | PORTLAND |
| State | OR |
| Zip Code | 97213-2933 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255337572 | John F Zurasky | Psychiatry & Neurology | 4805 Ne Glisan St, Ste 3g37, Portland, OR 97213-2933 | 2005-06-22 |
| 1083228175 | Alysia M Paaluhi | Registered Nurse | 4805 Ne Glisan St, Portland, OR 97213-2933 | 2020-09-04 |
| 1619595964 | Kathleen Hahn | Dietitian, Registered | 4805 Ne Glisan St, Portland, OR 97213-2933 | 2020-07-13 |
| 1841839107 | Daniel Dean Rosema | Nurse Practitioner | 4805 Ne Glisan St, Portland, OR 97213-2933 | 2020-01-03 |
| 1588207666 | Jean Hannon Mullins-padgett | Nurse Practitioner | 4805 Ne Glisan St, Portland, OR 97213-2933 | 2019-10-22 |
| 1043853146 | Miranda Meyer | Dietitian, Registered | 4805 Ne Glisan St, Portland, OR 97213-2933 | 2019-10-21 |
| 1083260830 | Becky L Bowler | Nurse Practitioner | 4805 Ne Glisan St, Portland, OR 97213-2933 | 2019-08-16 |
| 1366096406 | Nicole W Engel | Registered Nurse | 4805 Ne Glisan St, Portland, OR 97213-2933 | 2019-07-26 |
| 1558924753 | Susan Lien | Nurse Practitioner | 4805 Ne Glisan St, Portland, OR 97213-2933 | 2019-04-15 |
| 1356809644 | Katheryne Zempel | Physical Therapist | 4805 Ne Glisan St, Portland, OR 97213-2933 | 2019-03-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831715176 | Darnell Jackie Strong | Social Worker | 435 Ne 78th Ave 'strong Counseling Services', Portland, OR 97213 | 2020-06-23 |
| 1336775907 | Redpoint Physical Therapy and Performance LLC | Physical Therapist | 4200 Ne Flanders St Unit B, Portland, OR 97213 | 2020-03-16 |
| 1801431218 | Denise Dorgan-miller | Occupational Therapy Assistant | Providence Elder Place, 4400 Ne Halsey Suite 200, Portland, OR 97213 | 2019-11-08 |
| 1619435617 | Aspiration of Character Counseling Services, LLC | Counselor | 4424 Ne Glisan St, The Li Wellness Building, Second Floor, Portland, OR 97213 | 2019-03-08 |
| 1578049631 | Credena Health LLC | Pharmacy | 4805 Ne Glisan St Ste 11n321, Portland, OR 97213 | 2018-07-12 |
| 1023507795 | Karissa Lynn Schwartz | Speech-Language Pathologist | Providence Portland Medical Center, 4805 Ne Glisan St, Portland, OR 97213 | 2018-05-08 |
| 1861944506 | James Livingston Taylor | Chiropractor | 5212 Ne Sacremento St., Portland, OR 97213 | 2016-10-28 |
| 1962958520 | Caitlin Turner | Massage Therapist | 4317 Ne Tillamook St., Portland, OR 97213 | 2016-09-01 |
| 1326407008 | Julianna Vermeys | Counselor | 4605 Ne Fremont St., 209a, Portland, OR 97213 | 2016-02-23 |
| 1881059822 | Thomas Michael Barrett | Counselor | 5228 Ne Hoyt St. Bldg. B, Portland, OR 97213 | 2015-12-17 |
| Find all providers in zip 97213 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770107302 | Vpa PC | Internal Medicine | 1500 Ne 15th Ave Apt 431, Portland, OR 97232-4418 | 2020-05-29 |
| 1073167730 | Oregon Adult Medicine PC | Internal Medicine | 2330 Nw Flanders St Ste 201, Portland, OR 97210-3460 | 2019-07-30 |
| 1265889265 | Jared Tobolski | Internal Medicine | 22 Bramhall St Dept Of, Portland, ME 04102-3175 | 2016-05-19 |
| 1528421039 | Celine Haotian Zhou | Internal Medicine | 3181 Sw Sam Jackson Park Rd, L-579, Ohsu, Portland, OR 97239 | 2016-04-01 |
| 1043685407 | Michael David Fox | Internal Medicine | 1015 Nw 22nd Ave # 230, Portland, OR 97210-3025 | 2015-12-09 |
| 1134516701 | Anne Longtine | Internal Medicine | 65 Waterville St, Portland, ME 04101 | 2015-04-22 |
| 1184016099 | Wendy W Yu | Internal Medicine | 9135 Sw Barnes Rd Ste 763, Portland, OR 97225-6777 | 2015-03-02 |
| 1639586191 | Stefan Christison | Internal Medicine | 1120 Nw 20th Ave Ste 110, Portland, OR 97209-1591 | 2014-07-16 |
| 1336551555 | Lee Michael Anthony | Internal Medicine | 9205 Sw Barnes Rd Mt-2800, Portland, OR 97225-6603 | 2014-05-22 |
| 1558772889 | Kyaw Zin Thein | Internal Medicine | 3485 S Bond Ave, Portland, OR 97239-4503 | 2014-05-08 |
| Find all providers in PORTLAND | ||||
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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.