MRS. JACQUELINE DENISE NICKSON-YOUNG (NPI# 1891835484) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891835484 |
| Entity Type | Individual |
| Full Name | MRS. JACQUELINE DENISE NICKSON-YOUNG |
| Credential | GNP-BC, APMHNP-C |
| Practice Address |
512 N Hampton Rd # 303 Desoto TX 75115-4920 |
| Practice Telephone | 4697344990 |
| Practice Fax Number | 9722553958 |
| Mailing Telephone | 4697344990 |
| Mailing Fax Number | 9722553958 |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2017-10-18 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LG0600X |
Nurse Practitioner Specialization: Gerontology |
568271 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
APRN LICENSE NO: | TX | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
512 N HAMPTON RD # 303 |
| City | DESOTO |
| State | TX |
| Zip Code | 75115-4920 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548860257 | Emeka Abazie Dds Pa | Dentist | 1001 N. Beckley, Suite 304, Desoto, TX 75115 | 2020-10-30 |
| 1407453384 | Heather Mcdowell | Massage Therapist | 100 Bob White St # 3, Desoto, TX 75115 | 2020-10-05 |
| 1295201580 | Daniel Max & Marcandrea, LLC | Optometrist | 1309 E. Pleasant Run Rd, Desoto, TX 75115 | 2018-10-15 |
| 1316432180 | Texas Home Health Group of De Soto, LLC | Home Health | 911 York Drive, Suite 203, De Soto, TX 75115 | 2018-06-25 |
| 1033606694 | Dental Health Associates of Texas, PC | Dentist | 1001 N Beckley, Desoto, TX 75115 | 2018-04-19 |
| 1023516093 | Joseph Chinaecherem Anya | Pharmacist | 805 Raintree Ln, Desoto, TX 75115 | 2018-01-25 |
| 1396253837 | Medical Care Innovation, P.C. | Clinic/Center | 2019 N Interstate 35 E, Desoto, TX 75115 | 2018-01-18 |
| 1124534888 | Herlonda Dotson | Counselor | 620 Candelila Drive, Desoto, TX 75115 | 2017-12-18 |
| 1053839548 | Floristene Johnson | Nutritionist | 1353 Armstrong Drive, Desoto, TX 75115 | 2017-09-05 |
| 1699290577 | Dlb Pharmacy LLC | Pharmacy | 1801 N Hampton, Suite 340, Desoto, TX 75115 | 2017-08-11 |
| Find all providers in zip 75115 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881235646 | Michael Besong Akwo-adelowo | Nurse Practitioner | 412 Sweet Gum Dr, Desoto, TX 75115-5847 | 2019-10-03 |
| 1447809983 | Witherspoon Mental Health and Wellness, Pllc | Nurse Practitioner | 2727 Bolton Boone Dr Ste 104b, Desoto, TX 75115-2019 | 2019-09-07 |
| 1043710239 | Elevate Mental Health Consultants | Nurse Practitioner | 1021 Lilac Ln, Desoto, TX 75115-1496 | 2018-02-14 |
| 1164974986 | Keisha Witherspoon | Nurse Practitioner | 1801 N Hampton Rd Ste 276, Desoto, TX 75115-2391 | 2016-10-27 |
| 1427301597 | Johnes Bogonko Monyoncho | Nurse Practitioner | 1229 E Pleasant Run Rd Ste 128, Desoto, TX 75115-4211 | 2012-10-26 |
| 1508407370 | Darren Shang | Nurse Practitioner | 941 York Dr Ste 205, Desoto, TX 75115-2066 | 2019-10-03 |
| 1306494547 | Eucharia Ndidi Onwubuya | Nurse Practitioner | 941 York Dr Ste 205, Desoto, TX 75115-2066 | 2019-08-30 |
| 1386292001 | Kimberly Nneka Onwubuya | Nurse Practitioner | 941 York Dr Ste 205, Desoto, TX 75115-2066 | 2019-08-27 |
| 1326518085 | Roel Sepulveda | Nurse Practitioner | 941 York Dr Ste 205, Desoto, TX 75115-2066 | 2018-11-26 |
| 1982110573 | Johnes & Gerald, LLC | Nurse Practitioner | 1229 E Pleasant Run Rd Ste 128, Desoto, TX 75115-4211 | 2017-12-19 |
| Find all providers in DESOTO | ||||
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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.