MR. DOUGLAS L JACKSON (NPI# 1912076639) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912076639 |
| Entity Type | Individual |
| Full Name | MR. DOUGLAS L JACKSON |
| Credential | CRNA |
| Practice Address |
100 Peyton Way Suite 200 Charleston WV 25309-8572 |
| Practice Telephone | 3043469400 |
| Practice Fax Number | 3043457320 |
| Mailing Telephone | 3043469400 |
| Mailing Fax Number | 3043457320 |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2018-04-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 367500000X | Nurse Anesthetist, Certified Registered | 55066 | WV | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | 1018491740002 | 05 | |
| OH | 2732038 | 05 | |
| WV | RAILROAD MEDICARE | P00416433 | 01 |
| WV | BRICKSTREET PROVIDER NUMBER | 1071290 | 01 |
| WV | BRICKSTREET RELATED PROVIDER | 27005299701 | 01 |
| MD | 412414600 | 05 | |
| WV | MEDICARE PTAN ROSTER 9333201 | JA8242301 | 01 |
| WV | 3810007540 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730384744 | Douglas Reed Jackson | Neuromusculoskeletal Medicine & OMM | 3211 Applewood Rd, Midland, MI 48640-2666 | 2007-06-19 |
| 1245367655 | Douglas Wayne Jackson | Dentist | 5540 S 79th E Place, Tulsa, OK 74145-7846 | 2007-02-27 |
| 1457401762 | Douglas Jackson | Dentist | 714 E. 4th Ave, Red Springs, NC 28377 | 2007-01-11 |
| 1063432342 | Douglas R Jackson | Family Medicine | 517 W Junipero St Unit 1, 334 S Patterson Ave #120, Santa Barbara, CA 93105-4239 | 2006-07-20 |
| 1760412241 | Douglas Gilbert Jackson I | Nurse Practitioner | 14827 Foothill Rd, Santa Paula, CA 93060-9733 | 2006-07-03 |
| 1962472407 | Douglas T Jackson | Anesthesiology | 150 Bargen St, F 102, Newark, NJ 07103 | 2006-01-26 |
| 1184277857 | Douglas Jackson | Nurse Practitioner | 1100 Reid Pkwy, Richmond, IN 47374-1157 | 2019-07-22 |
| 1427394147 | Douglas Ray Jackson | Pharmacist | 600 Sheldon St, Creston, IA 50801-3322 | 2012-12-27 |
| 1891071635 | Douglas Scott Jackson | Pharmacist | 116 S George St, Suite 101, York, PA 17401-1474 | 2011-10-25 |
| 1013160316 | Douglas Clarence Jackson | Specialist | 2384 Atlantic Ave, Brooklyn, NY 11233-3402 | 2008-10-30 |
| Street Address |
100 PEYTON WAY SUITE 200 |
| City | CHARLESTON |
| State | WV |
| Zip Code | 25309-8572 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851328116 | Cynthia H Mccall | Counselor | 100 Peyton Way, Charleston, WV 25314 | 2006-06-26 |
| 1346435799 | Heather Eastwood | Chiropractor | 100 Peyton Way, Suite 201, Charleston, WV 25309 | 2007-09-10 |
| 1699960351 | Southridge Advanced Chiropractic | Chiropractor | 100 Peyton Way, Suite 201, Charleston, WV 25309-8572 | 2007-09-06 |
| 1831284116 | Timothy Lawrence Thistlethwaite | Psychiatry & Neurology | 100 Peyton Way, Suite 100, Charleston, WV 25309-8767 | 2006-10-04 |
| 1386738508 | Tim Thistlethwaite, M.d. Pllc | Counselor | 100 Peyton Way, Suite 100, Charleston, WV 25309-8767 | 2006-10-03 |
| 1295839389 | Jody Ryan Eastwood | Chiropractor | 100 Peyton Way, Suite 201, Charleston, WV 25309-8572 | 2006-09-11 |
| 1306857743 | Julie Ann Sayre | Nurse Anesthetist, Certified Registered | 100 Peyton Way, Suite 200, Charleston, WV 25309-8767 | 2006-08-10 |
| 1083639421 | Rebecca Oyler Sullivan | Registered Nurse | 100 Peyton Way, Ste 200, Charleston, WV 25309-8767 | 2006-07-13 |
| 1245265206 | David Lee Caraway | Anesthesiology | 100 Peyton Way, Ste 200, Charleston, WV 25309-8767 | 2006-07-11 |
| 1497787501 | Gale A Thompson | Psychologist | 100 Peyton Way, Charleston, WV 25314 | 2006-07-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699376905 | Lovie Bradshaw | Technician | 4823 Tennessee St., South Charleston, WV 25309 | 2020-11-03 |
| 1306447735 | Barbara Mackenzie | Technician | 4224 Kanawha Turnpike, South Charleston, WV 25309 | 2020-11-03 |
| 1548861974 | Sarah Nichols | Technician | 4990 Colonial Park Dr. Apt. F, South Charleston, WV 25309 | 2020-11-03 |
| 1629690177 | Jennifer Mabry-goins | Technician | 4505 River Avenue, S Charleston, WV 25309 | 2020-05-07 |
| 1811537715 | Brandon C Dean | Psychologist | 4857 Macorkle Ave. Sw, South Charleston, WV 25309 | 2020-01-09 |
| 1467096057 | Linda Mullins | Technician | 60 Hayvon Lane, South Charleston, WV 25309 | 2019-11-06 |
| 1831743616 | Ann Myriah Beck | Nurse Practitioner | 4610 Maccorkle Ave Sw # 300, South Charleston, WV 25309 | 2019-07-30 |
| 1942671227 | Edward W Eskew | Family Medicine | 4605 Maccorkle Avenue, Sw, Thspp-psychiatry, South Charleston, WV 25309 | 2015-10-13 |
| 1720468218 | Link Investments LLC | Pharmacy | 5151 Macorkle Avenue, South Charleston, WV 25309 | 2015-06-01 |
| 1366840951 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 304 Southbridge Blvd., S.ccharleston, WV 25309 | 2014-12-12 |
| Find all providers in zip 25309 | ||||
| Taxonomy Code | 367500000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Anesthetist, Certified Registered |
| (1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition. |
| Notes: Sources: (1) Council on Certification of Nurse Anesthetists, Park Ridge, IL, and Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. (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. 548. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164914552 | Amanda R Dipiazza | Nurse Anesthetist, Certified Registered | 9330 Medical Plaza Dr Ste E, Charleston, SC 29406 | 2018-06-01 |
| 1043746464 | Victoria Lorraine Nester | Nurse Anesthetist, Certified Registered | 3018 Cane Fork Rd, Charleston, WV 25314-9002 | 2017-05-04 |
| 1417308891 | Erik Meadows | Nurse Anesthetist, Certified Registered | 121 Hickory Rd, Charleston, WV 25314-1823 | 2016-06-27 |
| 1194175265 | Bethany Daniel | Nurse Anesthetist, Certified Registered | 644 Gordon Dr, Charleston, WV 25314-1762 | 2016-06-20 |
| 1790117356 | Benjamin Michael Blick | Nurse Anesthetist, Certified Registered | 402 Bow Hunter Rd, Charleston, WV 25314-2458 | 2013-08-06 |
| 1972805802 | Bradford Clinton Buddenberg | Nurse Anesthetist, Certified Registered | 2215 Smith Rd, Charleston, WV 25314-2110 | 2010-11-29 |
| 1750619011 | Ashlea Renea King | Nurse Anesthetist, Certified Registered | 12 Jamestown Rd, Charleston, WV 25314-1976 | 2009-11-25 |
| 1013152644 | Meg Adair Jackson | Nurse Anesthetist, Certified Registered | 3200 Maccorkle Ave S. E., Charleston, WV 25304 | 2008-12-11 |
| 1316198161 | Tabitha Renee Stutler | Nurse Anesthetist, Certified Registered | 800 Penssylvania Ave, Charleston, WV 25302 | 2008-10-09 |
| 1194997536 | Priscilla Joyce Walkup | Nurse Anesthetist, Certified Registered | 3110 Maccorkle Ave, S.e., Room 2042 Robert C. Byrd Bld, Charleston, WV 25304-1833 | 2008-03-26 |
| Find all providers in CHARLESTON | ||||
| City | CHARLESTON |
| Zip Code | 25309 |
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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.