RANDY ALAN JACKSON (NPI# 1689832768) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689832768 |
| Entity Type | Individual |
| Full Name | RANDY ALAN JACKSON |
| Credential | M.D. |
| Practice Address |
2602 Saint Michael Dr Suite 205 Texarkana TX 75503-2387 |
| Mailing Address |
7203 Bringle Rdg Texarkana TX 75503-5460 |
| Practice Telephone | 9036145111 |
| Mailing Telephone | 9033061185 |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2009-05-26 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | N0854 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | BCBS OF TEXAS | 8BU284 | 01 |
| OK | 200235880 A | 05 | |
| AR | 176329001 | 05 | |
| TX | 200544901 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407470719 | Randy Jackson | Nurse Anesthetist, Certified Registered | 280 Pattonsville Rd, Jackson, OH 45640-9452 | 2020-06-02 |
| 1750807442 | Randy Jackson | Home Health Aide | 9837 E Natal Ave, Mesa, AZ 85209-2588 | 2017-08-15 |
| 1437681301 | Randy Jackson Jr. | Student in an Organized Health Care Education/Training Program | 6420 Clayton Rd, Room 2234, Saint Louis, MO 63117-1811 | 2017-03-30 |
| 1518184282 | Randy Jackson | Registered Nurse | 2250 Hickory Rd, Suite 240, Plymouth Meeting, PA 19462-1047 | 2007-04-20 |
| 1770662967 | Randy Jackson | Counselor | 200 Mcgee Rd, Anderson, SC 29625-2104 | 2006-11-06 |
| 1629010707 | Randy H Jackson | Physician Assistant | 743 Spring St Ne, Gainesville, GA 30501-3715 | 2006-06-12 |
| 1508825357 | Randy D Jackson | Physician Assistant | 200 Somerset St, Suite 2, Millinocket, ME 04462-1258 | 2006-03-21 |
| Street Address |
2602 SAINT MICHAEL DR SUITE 205 |
| City | TEXARKANA |
| State | TX |
| Zip Code | 75503-2387 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245235092 | Richard Jackson Payne | Specialist | 2602 Saint Michael Dr, Suite 301, Texarkana, TX 75503-2387 | 2005-06-17 |
| 1306169701 | Cassie Lee Gonzales | Nurse Practitioner | 2602 Saint Michael Dr, Texarkana, TX 75503-2387 | 2010-03-12 |
| 1720216476 | Joshua Gilchrist | Family Medicine | 2602 Saint Michael Dr, Suite 205, Texarkana, TX 75503-2387 | 2009-07-01 |
| 1134383250 | Kiplan Trey Menefee | Anesthesiology | 2602 Saint Michael Dr, Suite 301, Texarkana, TX 75503-2387 | 2008-07-17 |
| 1194936013 | John J Harris | Emergency Medicine | 2602 Saint Michael Dr, Suite 204, Texarkana, TX 75503-2387 | 2007-05-24 |
| 1588706485 | Independent Anesthesia of Texarkana, L.l.p | Anesthesiology | 2602 Saint Michael Dr, Suite 301, Texarkana, TX 75503-2387 | 2007-02-14 |
| 1245334374 | James Patrick Williams | Anesthesiology | 2602 Saint Michael Dr, Suite 301, Texarkana, TX 75503-2387 | 2006-09-11 |
| 1013028646 | Osei Kwame Asamoah | Emergency Medicine | 2602 Saint Michael Dr, Texarkana, TX 75503-2387 | 2006-08-31 |
| 1306869706 | Forrest E. Asher | Counselor | 2602 Saint Michael Dr, Suite 203, Texarkana, TX 75503-2387 | 2006-07-26 |
| 1114947900 | Suman Sinha | Internal Medicine | 2602 Saint Michael Dr, Suite 400, Texarkana, TX 75503-2387 | 2006-07-21 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770049397 | Jeffery Nash | Nurse Practitioner | #4 Valley View Circle, Texarkana, TX 75503 | 2019-02-19 |
| 1821583501 | Brandy D Acker | Psychologist | 3615 Richmond Rd, Texarkana, TX 75503 | 2018-06-26 |
| 1366935066 | Samantha Lee Harris | Nurse Practitioner | 4116 Mcknight Rd, Texarkana, TX 75503 | 2018-06-07 |
| 1811416910 | Heather Alison Gerber | Nurse Practitioner | 5903 Brenda Street, Texarkana, TX 75503 | 2017-09-11 |
| 1952838682 | John Kyle Abney | Counselor | 4134 Mcknight Rd, Texarkana, TX 75503 | 2017-05-12 |
| 1699151514 | Piney Woods Er IIi LLC | Clinic/Center | 4102 Gibson Lane, Texarkana, TX 75503 | 2015-08-03 |
| 1609282433 | Colby Rebecca Pair | Physician Assistant | 2604 St. Michael Dr., Suite 310, Texarkana, TX 75503 | 2014-07-01 |
| 1265842496 | Healthcare Express, LLP | Clinic/Center | 3513 Richmond Rd, Texarkana, TX 75503 | 2014-04-28 |
| 1134540628 | Eagle Dental Center of Texarkana Pllc | Dentist | 4009 Moores Ln, Texarkana, TX 75503 | 2013-12-30 |
| 1326481664 | Juancarlo S. Pascual | Family Medicine | 604 St. Michael Dr, Suite 340, Texarkana, TX 75503 | 2013-04-16 |
| Find all providers in zip 75503 | ||||
| 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 |
|---|---|---|---|---|
| 1851699425 | Fred Atkinson Hutcheson Jr. | Internal Medicine | 3803 Colorado St, Texarkana, TX 75503-2812 | 2011-03-07 |
| 1376796037 | James Bernard Weedman | Internal Medicine | 1600 Arkansas Blvd Ste 100, Texarkana, AR 71854-1681 | 2008-10-28 |
| 1568636413 | Elie J Toubia | Internal Medicine | 1002 Texas Blvd Ste 201, Texarkana, TX 75501-5133 | 2008-04-22 |
| 1750394441 | Beverly J Greer-simpson | Internal Medicine | 910 Realtor Avenue, Veterans Outpatient Clinic of Texarkana, Texarkana, AR 71854 | 2006-08-14 |
| 1306888243 | Texarkana Internal Medicine Association Pa | Internal Medicine | 4082 Summerhill Sq, Texarkana, TX 75503-2730 | 2006-06-12 |
| 1841245883 | Jack R Childress | Internal Medicine | 2602 Saint Michael Dr Ste 205, Texarkana, TX 75503-2378 | 2006-05-24 |
| 1033187299 | Charles Chibundu Mbonu | Internal Medicine | 2604 St. Michael Drive, Suite 310, Texarkana, TX 75503 | 2006-03-14 |
| 1093796534 | Nathan J Wright | Internal Medicine | 2014 Galleria Oaks Dr, Texarkana, TX 75503-4620 | 2005-11-10 |
| 1851385793 | Donald Stratton Douglas | Internal Medicine | 3510 Richmond Rd, Suite C, Texarkana, TX 75503-0705 | 2005-09-07 |
| 1063417822 | Thomas Alston | Internal Medicine | 1400 College Dr, Ste 202, Texarkana, TX 75503-3575 | 2005-06-17 |
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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.