DR. STACEY MARIE JACKSON (NPI# 1588189310) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1588189310 |
Entity Type | Individual |
Full Name | DR. STACEY MARIE JACKSON |
Other Name | STACEY MARIE EHRENBERG |
Credential | PSYD |
Practice Address |
11 Nealy Blvd Hampton VA 23665 |
Mailing Address |
11 Nealy Blvd Hampton VA 23665-2023 |
Practice Telephone | 7577646840 |
Enumeration Date | 2017-08-14 |
Last Update Date | 2019-10-18 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 103TC0700X |
Psychologist Specialization: Clinical |
08100006337 | VA | Behavioral Health & Social Service Providers |
N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
Address | Telephone Number | Fax Number |
---|---|---|
5130 E Clinton Way, Fresno, CA 937272014 | 5525322277 | |
4881 Sugar Maple Dr, Wright Patterson Afb, OH 454335529 | 9372576877 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1134645674 | Stacey Jackson | Nurse Practitioner | 1604 Hospital Pkwy Ste 100, Bedford, TX 76022-5913 | 2017-08-16 |
1508301292 | Stacey Jackson | Registered Nurse | 1015 S Broadway, Suite 18, Minot, ND 58701-4667 | 2017-01-04 |
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 |
11 NEALY BLVD |
City | HAMPTON |
State | VA |
Zip Code | 23665 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1982228938 | Mai Stern | Student in an Organized Health Care Education/Training Program | Langley Afb Dental Clinic, Hampton, VA 23665 | 2020-06-05 |
1386273449 | Nicholas Thomas Nelson | Military Health Care Provider | 633d Medical Group, 76 Nealy Ave, Building #92, Apo, AA 23665 | 2020-04-02 |
1316574809 | Kimberly C Easterling | Student in an Organized Health Care Education/Training Program | 76 Nealy Avenue, Joint Base Langley-eustis, Hampton, VA 23665 | 2020-03-24 |
1851950026 | Erin Leigh Baldridge | Dentist | Joint Base Langley Eustis Dental Clinic, 76 Nealy Ave, Apo, AA 23665 | 2019-06-11 |
1669950739 | Anthony Interrante IIi | Nurse Practitioner | Usaf Hospital Langley, 77 Nealy Avenue, Hampton, VA 23665 | 2018-08-01 |
1285062216 | Michael John Vietti | Physician Assistant | 633 Mdg 77 Nealy Ave, Yorktown, VA 23665 | 2013-10-30 |
1396182234 | Micaela Jane Dagucon | General Practice | 633d Mdg/sghc, 77 Nealy Avenue, Joint Base Langley-eustis, VA 23665 | 2013-06-02 |
1912212051 | Michele Leigh Shirley | Pharmacist | 633d Medical Group Hospital, 77 Nealy Avenue, Building 257, Joint Base Langley-eustis, VA 23665 | 2010-08-13 |
1497915219 | Stephen Warren Porter | Dentist | 76 Nealy Ave, 1st Dental Squadron/sgd, Langley Air Force Base, VA 23665 | 2008-06-16 |
1336299122 | Michael Gardner | Family Medicine | 633d Air Base Wing, Family Health Clinic, 77 Nealy Drive, Langley Afb, VA 23665 | 2007-01-12 |
Find all providers in zip 23665 |
Taxonomy Code | 103TC0700X |
Grouping | Behavioral Health & Social Service Providers |
Classification | Psychologist |
Specialization | Clinical |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1043633944 | Marie Barrett | Psychologist | 39 Ash Ave Bldg 289, Hampton, VA 23665-2011 | 2014-01-28 |
1417131798 | Earle Harris Williams II | Psychologist | 2012 Cunningham Dr Ste 101, Hampton, VA 23666-3448 | 2007-12-22 |
1427109958 | Gail M Dunfey | Psychologist | 234 Lafayette Rd, Hampton, NH 03842-4105 | 2007-01-12 |
1316008105 | Catharine E. Randazzo | Psychologist | 28 State Route 173, Suite 4, Hampton, NJ 08827-4003 | 2006-12-13 |
1902869001 | Joanne Shovlin | Psychologist | 171 Extended Care, Veterans Affairs Medical Center, Hampton, VA 23667-0001 | 2006-04-10 |
1013978451 | Donald Epstein | Psychologist | 1000 Emancipation Drive, Hampton, VA 23667 | 2006-03-28 |
1285241570 | Larry N. Wootten | Psychologist | 100 Emancipation Dr, Hampton, VA 23667-0001 | 2020-09-30 |
1639788268 | Shan S. Wong | Psychologist | 100 Emancipation Dr, Hampton, VA 23667-0001 | 2020-07-29 |
1205454352 | Charity Seitz | Psychologist | 100 Emancipation Dr, Hampton, VA 23667-0001 | 2020-07-06 |
1144858424 | Fallon Trent | Psychologist | 100 Emancipation Dr, Hampton, VA 23667-0001 | 2020-03-31 |
Find all providers in HAMPTON |
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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.