ROBERT DALE JACKSON (NPI# 1881076230) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881076230 |
| Entity Type | Individual |
| Full Name | ROBERT DALE JACKSON |
| Credential | PA-S |
| Practice Address |
4311 11th Ave Ne Ste 200 Seattle WA 98105 |
| Mailing Address |
4311 11th Ave Ne Ste 200 Seattle WA 98105-6367 |
| Practice Telephone | 2066164001 |
| Practice Fax Number | 2066163889 |
| Mailing Telephone | 2066164001 |
| Mailing Fax Number | 2066163889 |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2018-08-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 246RP1900X |
Technician, Pathology Specialization: Phlebotomy |
PC60573205 | WA | Technologists, Technicians & Other Technical Service Providers |
| N | 246Z00000X | Specialist/Technologist, Other | MR60568577 | WA | Technologists, Technicians & Other Technical Service Providers |
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | WASHINGTON STATE LICENSE | MR60568577 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 914 W Carlisle Ave, Spokane, WA 992053309 | 5093250393 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538701487 | Robert Jackson | Physical Therapist | 3056 Healthy Way Ste 116, Birmingham, AL 35243-2435 | 2019-10-11 |
| 1881003655 | Robert Donald Jackson | Social Worker | 151 Knollcroft Rd # 116d, Lyons, NJ 07939-5001 | 2014-08-06 |
| 1780005496 | Robert Earl Jackson Jr. | Community Health Worker | 17 Wickham Dr, Columbus, GA 31907-6328 | 2013-12-23 |
| 1073942371 | Robert Jackson | Massage Therapist | 502 11th St Se, Decatur, AL 35601-4908 | 2013-11-06 |
| 1447548573 | Robert Joseph Jackson | Licensed Practical Nurse | 5454 East State St, Hermitage, PA 16148 | 2011-07-11 |
| 1457515330 | Robert Anthony Jackson | Dentist | 2816 Veach Rd., Unit 305, Owensboro, KY 42303 | 2008-07-10 |
| 1437357399 | Robert D Jackson | Counselor | 5525 Erindale Dr Ste 112, Colorado Springs, CO 80918-6960 | 2007-07-03 |
| 1174736029 | Robert Allan Jackson | Physician Assistant | 2109 Brookview Ter Apt B, Pekin, IL 61554-7320 | 2007-05-08 |
| 1144389347 | Robert W Jackson | Dentist | 209 Mimosa Dr, Thomasville, GA 31792-6633 | 2006-12-06 |
| 1144305152 | Robert Eric Jackson | Internal Medicine | 291 Indian Lake Blvd, Hendersonville, TN 37075-3653 | 2006-10-26 |
| Street Address |
4311 11TH AVE NE STE 200 |
| City | SEATTLE |
| State | WA |
| Zip Code | 98105 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104092758 | Raymond William Weinrich | Technician, Other | 4311 11th Ave Ne Ste 200, Seattle, WA 98105-6367 | 2008-05-05 |
| 1801402532 | Alexandria Zena Lahdya | Student in an Organized Health Care Education/Training Program | 4311 11th Ave Ne Ste 200, Seattle, WA 98105-6367 | 2020-09-18 |
| 1932715877 | Elizabeth Newkirk | Student in an Organized Health Care Education/Training Program | 4311 11th Ave Ne Ste 200, Seattle, WA 98105-6367 | 2020-09-16 |
| 1821603978 | Kelly Cook | Student in an Organized Health Care Education/Training Program | 4311 11th Ave Ne Ste 200, Seattle, WA 98105-6367 | 2020-09-14 |
| 1659986263 | Katherine Anna Schmidt | Student in an Organized Health Care Education/Training Program | 4311 11th Ave Ne Ste 200, Seattle, WA 98105-6367 | 2020-09-10 |
| 1174138945 | Craig Dyess | Student in an Organized Health Care Education/Training Program | 4311 11th Ave Ne Ste 200, Seattle, WA 98105-6367 | 2020-09-09 |
| 1881209724 | Michael Kenner | Student in an Organized Health Care Education/Training Program | 4311 11th Ave Ne Ste 200, Seattle, WA 98105-6367 | 2020-09-08 |
| 1932713948 | Christine Baldwin | Student in an Organized Health Care Education/Training Program | 4311 11th Ave Ne Ste 200, Seattle, WA 98105-6367 | 2020-09-08 |
| 1477167476 | Annabelle Joy Carney | Student in an Organized Health Care Education/Training Program | 4311 11th Ave Ne Ste 200, Seattle, WA 98105-6367 | 2020-09-07 |
| 1841804994 | Eli Patrick Burnham | Student in an Organized Health Care Education/Training Program | 4311 11th Ave Ne Ste 200, Seattle, WA 98105-6367 | 2020-09-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326662396 | Dale Justin Podolsky | Student in an Organized Health Care Education/Training Program | 4800 Sand Point Way Ne, Ob.9.520, Seattle Children's, Seattle, WA 98105 | 2020-06-04 |
| 1376170878 | Andrew Crompton Yazman | Pediatrics | 4800 Sand Point Way, Ne Oc.7.830, Seattle, WA 98105 | 2020-03-25 |
| 1427688845 | Daniela Michell Zepeda | Behavioral Analyst | 4616 25th Ave Ne Pmb 437, Seattle, WA 98105 | 2020-01-24 |
| 1255981189 | Emily King | Student in an Organized Health Care Education/Training Program | Mark Hawkins, Pa-c, Mpas, 4311 11th Ave Ne Suite 200, WA 98105 | 2019-09-12 |
| 1821659327 | Sara Katherine Horne | Student in an Organized Health Care Education/Training Program | 4800 Sand Point Way Ne, Mb.11.500, Department of Anesthesiology and Pain Medicine, Seattle, Seattle, WA 98105 | 2019-06-25 |
| 1881252575 | Darryl Lee Wright | Peer Specialist | Gossett Place, 4719 12th Ave Ne, Seattle, WA 98105 | 2019-05-29 |
| 1487117891 | Nirupama Madhavan | Behavioral Analyst | 5001 25th Ave Ne, Seattle, WA 98105 | 2019-04-11 |
| 1780155648 | Eryn R Mcentee | Naturopath | 2216 Ne46th St, Seattle, WA 98105 | 2018-12-17 |
| 1356811921 | Kyle Leland Bernbach | Massage Therapist | 5224 Ravenna Ave Ne, Seattle, WA 98105 | 2018-11-27 |
| 1548742380 | Janal Kim | Physician Assistant | 4726 11th Ave Ne, Apt 511, Seattle, WA 98105 | 2018-08-29 |
| Find all providers in zip 98105 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396342358 | Emma Peconga | Student in an Organized Health Care Education/Training Program | 3619 Ashworth Ave N, Seattle, WA 98103-8116 | 2020-10-02 |
| 1780290361 | Compassionate Peer Counseling LLC | Student in an Organized Health Care Education/Training Program | 3250 Airport Way S Ste 608, Seattle, WA 98134-2172 | 2020-09-19 |
| 1336751684 | Binabahen Shah | Student in an Organized Health Care Education/Training Program | 6035 4th Ave Nw, Seattle, WA 98107-2109 | 2020-08-18 |
| 1316558968 | Jimmy Nguyen | Student in an Organized Health Care Education/Training Program | 5525 23rd Ave S, Seattle, WA 98108-2918 | 2020-08-16 |
| 1174133672 | Selomie Habtemichael | Student in an Organized Health Care Education/Training Program | 10000 30th Ave Sw, Seattle, WA 98146-3720 | 2020-08-09 |
| 1659980720 | Joseph Banham | Student in an Organized Health Care Education/Training Program | 12057 Lakeside Pl Ne, Seattle, WA 98125-5956 | 2020-07-24 |
| 1326662396 | Dale Justin Podolsky | Student in an Organized Health Care Education/Training Program | 4800 Sand Point Way Ne, Ob.9.520, Seattle Children's, Seattle, WA 98105 | 2020-06-04 |
| 1659993723 | Caroline Mullins | Student in an Organized Health Care Education/Training Program | 701 N 36th St Ste 3000, Seattle, WA 98103-8868 | 2020-05-12 |
| 1730700741 | Christian Van Rooyen | Student in an Organized Health Care Education/Training Program | 1951 Pacific Street, Seattle, WA 98195 | 2020-04-30 |
| 1669092128 | Ahmed Abdelrazek | Student in an Organized Health Care Education/Training Program | 1959 Ne Pacific Street, 356560, Department of Psychiart, Seattle, WA 98195-6560 | 2020-04-24 |
| Find all providers in SEATTLE | ||||
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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.