SUSAN MARIE JACKSON (NPI# 1689914087) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689914087 |
| Entity Type | Individual |
| Full Name | SUSAN MARIE JACKSON |
| Credential | CNP |
| Practice Address |
4805 Montgomery Rd Ste 410 Cincinnati OH 45212 |
| Mailing Address |
4805 Montgomery Rd Ste 150 Cincinnati OH 45212-2280 |
| Practice Telephone | 5135591222 |
| Practice Fax Number | 5135591235 |
| Mailing Telephone | 5139615558 |
| Mailing Fax Number | 5139611912 |
| Enumeration Date | 2013-02-21 |
| Last Update Date | 2018-05-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | RN.259883-COA1 | OH | Nursing Service Providers |
| N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
1135253 | KY | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
CNP.13953 | OH | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407316003 | Susan Jackson | Pharmacist | 1022 Sealyham Ct, Reynoldsburg, OH 43068-4763 | 2019-03-21 |
| 1831624113 | Susan Jackson | Speech-Language Pathologist | 616 W Virginia Ave, Sebring, OH 44672-1142 | 2017-04-25 |
| 1487064986 | Susan Jackson | Social Worker | 425 W 48th St, 4k, New York, NY 10036 | 2014-05-06 |
| 1538476601 | Susan Jackson | Pharmacist | 5540 S 900 E, Salt Lake City, UT 84117-7206 | 2010-09-09 |
| 1609042639 | Susan Jackson | Physical Therapist | 3275 Soft Breeze Cir, West Melbourne, FL 32904-7710 | 2008-04-30 |
| 1073781613 | Susan Jean Jackson | Physical Therapist | 901 W 9th St Apt 414, Austin, TX 78703-4629 | 2008-02-18 |
| 1699951368 | Susan Elizabeth Jackson | Nurse Practitioner | 20 Mair Ave, Totowa, NJ 07512-2313 | 2008-01-12 |
| 1780749671 | Susan Marie Jackson | Family Medicine | 25066 Sr 11, Hallstead, PA 18822 | 2006-12-22 |
| 1871048520 | Susan Marie Jackson | Case Manager/Care Coordinator | 1125 W 6th St, Los Angeles, CA 90017-1833 | 2016-08-23 |
| 1760835300 | Susan H Jackson | Marriage & Family Therapist | 8350 Archibald Ave Ste 125, Rancho Cucamonga, CA 91730-7701 | 2016-07-19 |
| Street Address |
4805 MONTGOMERY RD STE 410 |
| City | CINCINNATI |
| State | OH |
| Zip Code | 45212 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528003548 | Marsha S Smith | Psychiatry & Neurology | 4805 Montgomery Rd Ste 410, Cincinnati, OH 45212-2280 | 2006-06-17 |
| 1841840071 | Samantha Dimeo | Nurse Practitioner | 4805 Montgomery Rd Ste 410, Cincinnati, OH 45212 | 2019-09-19 |
| 1336632397 | Jessica Nurre | Nurse Practitioner | 4805 Montgomery Rd Ste 410, Cincinnati, OH 45212-2198 | 2018-06-13 |
| 1922531573 | Anona Nicole Archer | Nurse Practitioner | 4805 Montgomery Rd Ste 410, Cincinnati, OH 45212-2198 | 2017-04-10 |
| 1629465588 | Stephanie Ritter | Psychiatry & Neurology | 4805 Montgomery Rd Ste 410, Cincinnati, OH 45212 | 2015-04-18 |
| 1588009674 | Meredith Hawthorne | Physician Assistant | 4805 Montgomery Rd Ste 410, Cincinnati, OH 45212 | 2013-05-03 |
| 1710265350 | Sonal Bhalla | Internal Medicine | 4805 Montgomery Rd Ste 410, Cincinnati, OH 45212 | 2011-08-01 |
| 1609182898 | Shon George Michael | Psychiatry & Neurology | 4805 Montgomery Rd Ste 410, Cincinnati, OH 45212 | 2010-08-25 |
| 1699094532 | Michelle Carroll Bowman | Psychiatry & Neurology | 4805 Montgomery Rd Ste 410, Cincinnati, OH 45212-2280 | 2010-05-18 |
| 1366570533 | Madhuri Venkata Vallabhuni | Psychiatry & Neurology | 4805 Montgomery Rd Ste 410, Cincinnati, OH 45212-2198 | 2007-03-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013568930 | Kelly Diane Weber | Social Worker | Va Behavioral Health and Wellness Center, 4600 Smith Road, Norwood, OH 45212 | 2019-09-23 |
| 1629566039 | Jessica Lee Eckstein | Nurse Practitioner | 4805 Montgomery Rd Ste 154, Cincinnati, OH 45212 | 2018-05-01 |
| 1578092847 | Kerry Ellen Ragland | Counselor | 2300 Wall Street, Cincinnati, OH 45212 | 2017-06-08 |
| 1912256454 | Helen Virginia Blackshire | Occupational Therapy Assistant | 4750 Wesley Avenue Suite J, Cincinnati, OH 45212 | 2012-08-30 |
| 1902154933 | Shelby Davis Lewis | Social Worker | 4750 Wesley Avenue, Suite J, Cincinnati, OH 45212 | 2012-08-23 |
| 1366727133 | Kelly Gray | Pharmacist | 4605 Montgomery Road, Norwood, OH 45212 | 2011-10-12 |
| 1588981351 | Stephen M Zitelli | Family Medicine | 1775 Lexington Ave, Cincinnati, OH 45212 | 2010-05-03 |
| 1699952416 | David William Barr | Marriage & Family Therapist | 4301 Smith Road, Cincinnati, OH 45212 | 2008-01-23 |
| 1780704718 | Douglas A Dix | Dentist | 5451 Montgomery Road, Cincinnati, OH 45212 | 2007-03-31 |
| 1376615104 | Orthopedic Diagnostic & Treatment Ctr Inc | Orthopaedic Surgery | 4600 Smith Road, Suite B, Norwood, OH 45212 | 2006-11-15 |
| Find all providers in zip 45212 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639543176 | Trihealth G LLC | Nurse Practitioner | 10498 Montgomery Rd Ste D, Cincinnati, OH 45242-4416 | 2015-11-20 |
| 1104255447 | Patricia Adkins | Nurse Practitioner | 344 Princess Ct, Cincinnati, OH 45215-1013 | 2013-11-07 |
| 1922449859 | Arianna N Warfel | Nurse Practitioner | 4750 E Galbraith Rd Ste 210, Cincinnati, OH 45236-6705 | 2013-07-08 |
| 1881931764 | Mary Kay Barth | Nurse Practitioner | 5719 Kiplingwood Dr, Cincinnati, OH 45239-6609 | 2013-01-11 |
| 1215245147 | Alexis Santee Ranalli | Nurse Practitioner | 10525 Montgomery Rd., Cincinnati, OH 45242-4401 | 2010-09-14 |
| 1801929559 | Anna Maria Fox | Nurse Practitioner | 2123 Auburn Ave Ste 440, Cincinnati, OH 45219 | 2007-03-13 |
| 1346377835 | Mary Catherine Brady | Nurse Practitioner | 430 Deanview Dr, Cincinnati, OH 45224-1415 | 2007-02-28 |
| 1376603886 | Planned Parenthood Southwest Ohio Region | Nurse Practitioner | 2314 Auburn Avenue, Cincinnati, OH 45219 | 2006-12-12 |
| 1700861234 | Mindi Gardner | Nurse Practitioner | 4600 Montgomery Rd, Ste 105, Cincinnati, OH 45212-2697 | 2005-12-07 |
| 1619958436 | Pamela Phares | Nurse Practitioner | 1401 Steffen Ave, Cincinnati, OH 45215-2338 | 2005-11-09 |
| Find all providers in CINCINNATI | ||||
| City | CINCINNATI |
| Zip Code | 45212 |
Please comment or provide details below to improve the information on SUSAN MARIE JACKSON.
| 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.