ANGALENE DEAPEN JACKSON (NPI# 1770994766) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770994766 |
| Entity Type | Individual |
| Full Name | ANGALENE DEAPEN JACKSON |
| Other Name | ANGIE DEAPEN JACKSON |
| Credential | DO |
| Practice Address |
2800 E Broad St Ste 100 Mansfield TX 76063 |
| Mailing Address |
2800 E Broad St Ste 100 Mansfield TX 76063-6410 |
| Practice Telephone | 6825181035 |
| Mailing Telephone | 6825181035 |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2019-11-25 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | Q9384 | VI | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1500 S Main St, Fort Worth, TX 761044917 | 8177025474 |
| Street Address |
2800 E BROAD ST STE 100 |
| City | MANSFIELD |
| State | TX |
| Zip Code | 76063 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568518173 | Natalie Kathleen Moore | Obstetrics & Gynecology | 2800 E Broad St Ste 100, Mansfield, TX 76063-6410 | 2007-01-26 |
| 1275736480 | Heather Jarrell Havener | Obstetrics & Gynecology | 2800 E Broad St Ste 100, Mansfield, TX 76063-6410 | 2007-06-06 |
| 1952504276 | Robert Stephen Krombach | Obstetrics & Gynecology | 2800 E Broad St Ste 100, Mansfield, TX 76063-6410 | 2007-06-06 |
| 1003023979 | Katrina L Willie-musoma | Pediatrics | 2800 E Broad St Ste 100, Mansfield, TX 76063-6410 | 2007-05-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316558349 | Lindsey Vandyke, D.o. Pllc | Internal Medicine | 3150 E Broad Street, Ste 100, Mansfield, TX 76063 | 2020-08-13 |
| 1942819867 | Jennifer Que Chau Nguyen | Pharmacist | 980 U.S. 287 Frontage Rd #287, Mansfield, TX 76063 | 2020-07-27 |
| 1194346890 | Ana Maria Gonzalez | Dentist | 1600 Us Highway 287, Suite 102, Mansfield, TX 76063 | 2020-05-04 |
| 1245869080 | Stateserv Medical of Texas, LLC | Durable Medical Equipment & Medical Supplies | 7941 Rodeo Trail, Mansfield, TX 76063 | 2020-04-03 |
| 1649802232 | Mary Puanani Kamai | Nurse Practitioner | 1301 E. Debbie Lane, Suite 102 #1405, Mansfield, TX 76063 | 2020-02-11 |
| 1770123028 | Gladys Vera Nfodzo | Nurse Practitioner | 901 W. Broad St, Mansfield, TX 76063 | 2020-01-14 |
| 1669011300 | Alexa Smith | Nurse Practitioner | 2800 E Broad St #304, Mansfield, TX 76063 | 2019-12-28 |
| 1477190437 | Mel Rockwall LLC | Optometrist | 1701 East Broad Street, Ste 109, Mansfield, TX 76063 | 2019-12-09 |
| 1376185512 | Daniel Max & Marcandrea LLC | Optometrist | 1701 East Broad St., Ste 109, Mansfield, TX 76063 | 2019-10-09 |
| 1861046385 | Lacey Eaton | Counselor | 805 Killian Dr, Mansfield, TX 76063 | 2019-08-01 |
| Find all providers in zip 76063 | ||||
| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194385112 | Jasma Griffin | Obstetrics & Gynecology | 1200 Highway 287 N Ste 103, Mansfield, TX 76063-2874 | 2019-06-20 |
| 1295205037 | Paul W. Daum, M.d., P.l.l.c. | Obstetrics & Gynecology | 2800 E Broad St Ste 412, Mansfield, TX 76063-6414 | 2018-12-04 |
| 1992191829 | Bhavisha Bhakta Nunez | Obstetrics & Gynecology | 120 N Miller Rd Unit 300, Mansfield, TX 76063-9173 | 2015-04-07 |
| 1871912535 | Ruth Okiemute Arumala | Obstetrics & Gynecology | 1759 Broad Park Cir S Ste 101, Mansfield, TX 76063-7836 | 2014-04-09 |
| 1134562945 | Jessica Pearce | Obstetrics & Gynecology | 120 N Miller Rd Ste 300, Mansfield, TX 76063-9173 | 2013-04-10 |
| 1205126109 | Robin Patrice Kindred | Obstetrics & Gynecology | 2800 E Broad St Ste 212, Mansfield, TX 76063-6411 | 2011-04-12 |
| 1023288701 | Mansfield Obgyn Association | Obstetrics & Gynecology | 1770 E Broad St Suite 102, Mansfield, TX 70063 | 2008-03-10 |
| 1972709533 | Marian Zinnante, Md Pa | Obstetrics & Gynecology | 120 N. Miller Rd., Suite 300, Mansfield, TX 76063-9173 | 2007-06-21 |
| 1568518173 | Natalie Kathleen Moore | Obstetrics & Gynecology | 2800 E Broad St Ste 100, Mansfield, TX 76063-6410 | 2007-01-26 |
| 1447332473 | Erin Carpenter Westerholm | Obstetrics & Gynecology | 2800 East Broad Street, Suite 308, Mansfield, TX 76063 | 2006-10-19 |
| Find all providers in MANSFIELD | ||||
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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.