SUSAN M JACKSON (NPI# 1699889949) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699889949 |
| Entity Type | Individual |
| Full Name | SUSAN M JACKSON |
| Credential | FNP |
| Practice Address |
1450 Champlin Ave Utica NY 13502-3662 |
| Mailing Address |
Po Box 8155 Utica NY 13505 |
| Practice Telephone | 3156249000 |
| Practice Fax Number | 3156249003 |
| Mailing Telephone | 3157360155 |
| Mailing Fax Number | 3157320393 |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2020-03-09 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 264949 | NY | Nursing Service Providers |
| Y | 363L00000X | Nurse Practitioner | 332294 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 01866164 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1703 Genesee St, Utica, NY 13501 | 3157360155 | 3157320393 |
| 2305 Genesee St, Utica, NY 135016107 | 3156249000 |
| 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 |
1450 CHAMPLIN AVE |
| City | UTICA |
| State | NY |
| Zip Code | 13502-3662 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790776268 | Diane M Scalise | Nurse Practitioner | 1450 Champlin Ave, Utica, NY 13502-3662 | 2005-11-02 |
| 1225656648 | Casey Lynn Kilborne | Nurse Practitioner | 1450 Champlin Ave, Utica, NY 13502-3662 | 2020-07-13 |
| 1174036867 | Marjorie Naples | Dietitian, Registered | 1450 Champlin Ave, Utica, NY 13502-3662 | 2017-11-16 |
| 1336570589 | Sleep Disorders Lab of Central New York, LLC | Sleep Specialist, PhD | 1450 Champlin Ave, Suite 1, Utica, NY 13502-3662 | 2013-12-12 |
| 1194080291 | Pulmonary Critical Care and Sleep Medicine Pllc | Internal Medicine | 1450 Champlin Ave, Utica, NY 13502-3662 | 2012-07-05 |
| 1750689451 | Kamrul A. Khan | Psychiatry & Neurology | 1450 Champlin Ave, Utica, NY 13502-3662 | 2011-03-03 |
| 1376707521 | Anwar Wassel | Internal Medicine | 1450 Champlin Ave, Utica, NY 13502-3662 | 2008-07-16 |
| 1104098631 | Helen M Dolan | Registered Nurse | 1450 Champlin Ave, Utica, NY 13502-3662 | 2008-03-25 |
| 1669692638 | Yekaterina A Kashtanova | Internal Medicine | 1450 Champlin Ave, Utica, NY 13502-3662 | 2007-05-01 |
| 1487773461 | Dawn Marie Bard | Pediatrics | 1450 Champlin Ave, Utica, NY 13502-3662 | 2007-03-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477152627 | Mary Imogene Bassett Hospital | Pharmacy | 231 N Genesee St Fl 2, Utica, NY 13502 | 2020-10-20 |
| 1922635002 | Beth Ann Laporte | Social Worker | Drn Counseling & Consulting Services, 2621 Genesee Street, Utica, NY 13502 | 2020-03-26 |
| 1689216038 | Mary Ann Stockhauser | Dietitian, Registered | 917 Newport Rd, Utica, NY 13502 | 2019-10-16 |
| 1538659719 | Brenda Ann Cruse-malone | Social Worker | Mohawk Valley Psychiatric Center, Community Services Building 1400 Noyes St, Utica, NY 13502 | 2018-05-14 |
| 1184138265 | Genesee Street Medical Health | Psychiatry & Neurology | 286 Genesee St Ste 5, Utica, NY 13502 | 2017-11-28 |
| 1518470244 | Jeff Rohacek | Counselor | 1213 Court St., Suite 100, Utica, NY 13502 | 2017-11-16 |
| 1275044281 | Adam C Schwartz | Counselor | 122 Business Park Drive, Suite 1, Utica, NY 13502 | 2017-10-17 |
| 1346767175 | Jordynn Lynn Lee | Licensed Practical Nurse | 910 Mildred Ave, Utica, NY 13502 | 2017-08-23 |
| 1942751391 | Amanda Karla | Counselor | 502 Court Street Suite 210, Utica, NY 13502 | 2016-10-20 |
| 1407229974 | Hayley Hunt | Physician Assistant | 1658 Champlin Ave, Suite 335, Utica, NY 13502 | 2015-11-05 |
| Find all providers in zip 13502 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265077101 | Brittany Ross | Nurse Practitioner | 930 State Route 140 E, Utica, KY 42376-9003 | 2019-11-14 |
| 1982266763 | Amanda L Mccabe | Nurse Practitioner | 1676 Sunset Ave Fl 4, Utica, NY 13502-5416 | 2019-07-02 |
| 1902381411 | Alisha C Holloway | Nurse Practitioner | 11689 Squiers Blvd, Utica, MI 48315-5936 | 2018-10-01 |
| 1821311069 | Ann Marie Markey | Nurse Practitioner | 2535 Genesee Street, Utica, NY 13501 | 2010-03-02 |
| 1801094693 | Bonnie Sue Page Williams | Nurse Practitioner | 5917 Morris Road, Glen and Jeanine Steuner, Utica, NY 13502 | 2007-07-03 |
| 1669568317 | Natalya Akhtyrsky | Nurse Practitioner | 1676 Sunset Ave., Utica, NY 13502 | 2006-10-04 |
| 1790776268 | Diane M Scalise | Nurse Practitioner | 1450 Champlin Ave, Utica, NY 13502-3662 | 2005-11-02 |
| 1992793137 | Karen C Flick | Nurse Practitioner | 1213 Court St, Utica, NY 13502-3803 | 2005-10-12 |
| 1194368936 | Patricia Flihan | Nurse Practitioner | 1904 Genesee St, Utica, NY 13502-5646 | 2019-10-24 |
| 1083275564 | Kayla Lynn Miller | Nurse Practitioner | 1256 Culver Ave, Utica, NY 13501-4253 | 2019-06-25 |
| Find all providers in UTICA | ||||
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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.