Kelly Jackson (NPI# 1033653431, PAC ID# 2365727625) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is NURSE PRACTITIONER.
| Nation Provider ID (NPI) | 1033653431 |
| PAC ID by PECOS | 2365727625 |
| Professional Enrollment ID | I20170329000176 |
| Full Name | Kelly Jackson |
| Organization Legal Name | OLIVER STREET 5.01(A) INC. |
| Address |
1720 S Beckham 102 Dermatology Associates Tyler TX 75701-4464 |
| Phone Number | 9035346200 |
| Gender | F |
| Graduation Year | 2016 |
| Primary Specialty | NURSE PRACTITIONER |
| Group Practice PAC ID | 0042464125 |
| Number of Group Practice Members | 135 |
| Accepts Medicare Assignment | Y |
| Address | Phone | Organization |
|---|---|---|
| 1367 Dominion Plz, Tyler, TX 75703-1013 | 9035346200 | OLIVER STREET 5.01(A) INC. |
| 1720 S Beckham, 102 Dermatology Associates, Tyler, TX 75701-4464 | 9035346200 | OLIVER STREET 5.01(A) INC. |
| Organization Legal Name | OLIVER STREET 5.01(A) INC. |
| Physicians | 142 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Sam Awan | Dermatology | Oliver Street 5.01(a) Inc. | 4701 Medical Ctr Dr, Suite 1b, Mckinney, TX 75069-1831 |
| Trisha Jayantilal Patel | Dermatology | Oliver Street 5.01(a) Inc. | 8210 Walnut Hill Lane Pob 1, Suite 810, Dallas, TX 75231 |
| Calvin Lamont Williams | Dermatology | Oliver Street 5.01(a) Inc. | 9808 N Beach St, 600 Us Dermatology Partners, Fort Worth, TX 76244-6184 |
| Nancy Marchell | Dermatology | Oliver Street 5.01(a) Inc. | 1605 Rock Prairie Rd, Suite 300, College Station, TX 77845-8358 |
| Pamela N Murray | Physician Assistant | Oliver Street 5.01(a) Inc. | 5805 Coit Rd, Suite 203, Plano, TX 75093-6990 |
| Matthew Helm | Dermatology | Oliver Street 5.01(a) Inc. | 815 Pecan Grove Rd E, Us Dermatology Partners, Sherman, TX 75090-1768 |
| Matthew Thomas Hoffmann | Dermatology | Oliver Street 5.01(a) Inc. | 901 Walnut Hill Dr, Dermatology Associates, Longview, TX 75605-5054 |
| Young T Mcmahan | Dermatology | Oliver Street 5.01(a) Inc. | 300 Richland W Circle, 2c Dermatology Associates, Waco, TX 76712-7935 |
| Christine Lawson | Physician Assistant | Oliver Street 5.01(a) Inc. | 5030 Tennyson Pkwy, Plano, TX 75024-3002 |
| Weilan Z Johnson | Dermatology | Oliver Street 5.01(a) Inc. | 1300 E 6th Ave, Dermatology Associates, Belton, TX 76513-2810 |
| Street Address |
1720 S BECKHAM 102 DERMATOLOGY ASSOCIATES |
| City | TYLER |
| State | TX |
| Zip | 75701-4464 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| John K Campbell | Nurse Practitioner | Oliver Street 5.01(a) Inc. | 1720 S Beckham, 102 Dermatology Associates, Tyler, TX 75701-4464 |
| Bobbak Mansouri | Dermatology | Oliver Street 5.01(a) Inc. | 1720 S Beckham, 102 Dermatology Associates, Tyler, TX 75701-4464 |
| Lindsey A Hunter-ellul | Dermatology | Oliver Street 5.01(a) Inc. | 1720 S Beckham, 102 Dermatology Associates, Tyler, TX 75701-4464 |
| Allison C Wilbanks | Physician Assistant | Oliver Street 5.01(a) Inc. | 1720 S Beckham, 102 Dermatology Associates, Tyler, TX 75701-4464 |
| Jennifer D Holman | Dermatology | Oliver Street 5.01(a) Inc. | 1720 S Beckham, 102 Dermatology Associates, Tyler, TX 75701-4464 |
| Toby J Cason | Physician Assistant | Oliver Street 5.01(a) Inc. | 1720 S Beckham, 102 Dermatology Associates, Tyler, TX 75701-4464 |
| Loretta A Jones | Nurse Practitioner | Oliver Street 5.01(a) Inc. | 1720 S Beckham, 102 Dermatology Associates, Tyler, TX 75701-4464 |
| Kirk F Gautier | Physician Assistant | Oliver Street 5.01(a) Inc. | 1720 S Beckham, 102 Dermatology Associates, Tyler, TX 75701-4464 |
| Alicia Rose Adkison | Nurse Practitioner | Digestive Health Specialists of Tyler | 1720 S Beckham, Tyler, TX 75701-4464 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jose L Enriquez | Diagnostic Radiology | Tyler Radiology Associates, Pa | 1100 S Beckham, Tyler, TX 75701 |
| Frank P Reuter Jr. | Internal Medicine | 712 S Bois D Arc Ave, Tyler, TX 75701-1503 | |
| Tammy L Michaelsen | Chiropractic | Michaelsen Chiropractic Center, P.C. | 645 S Broadway Ave, Suite 1, Tyler, TX 75701-1676 |
| Mark R Michaelsen | Chiropractic | Michaelsen Chiropractic Center, P.C. | 645 S Broadway Ave, Suite 1, Tyler, TX 75701-1676 |
| James Louis Wasson | Obstetrics/gynecology | 649 S Broadway Ave, Suite 2, Tyler, TX 75701-1677 | |
| Michael C Ford | Ophthalmology | 714 Turtle Creek Dr, Tyler, TX 75701-1833 | |
| Rosalyn L Gooch | Certified Registered Nurse Anesthetist (crna) | Novamed Surgery Center of Tyler, Lp | 802 Turtle Creek Dr, Tyler, TX 75701-1900 |
| Evans S Smith | Emergency Medicine | 833 S Beckham Ave, Tyler, TX 75701-1905 | |
| Li-yu H Mitchell | Family Medicine | 833 S Beckham Ave, Tyler, TX 75701-1905 | |
| Joseph Leonard Decarlo | Urology | Etmc Physician Group, Inc. | 911 S Beckham Ave, Tyler, TX 75701-1907 |
| Find all physicians in zip 75701 | |||
| City | TYLER |
| Zip Code | 75701 |
| Specialty | NURSE PRACTITIONER |
| City + Specialty | TYLER + NURSE PRACTITIONER |
Please comment or provide details below to improve the information on Kelly Jackson.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.