Patricia Renee Jackson

Primary specialty

DentistTaxonomy code 122300000X

License

30.023852 Issued in OH

Practice address

191 Highway and Hospital Road
Chinle, AZ 86503

Phone

(928) 674-7166

Fax

(928) 674-7705

NPI assigned

May 13, 2012

Last updated

Oct 8, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1336867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381190400000",
    "number": "1023377967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO DRAWER PH",
            "city": "CHINLE",
            "state": "AZ",
            "postal_code": "86503",
            "telephone_number": "928-674-7166",
            "fax_number": "928-674-7705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 HIGHWAY AND HOSPITAL ROAD",
            "city": "CHINLE",
            "state": "AZ",
            "postal_code": "86503",
            "telephone_number": "928-674-7166",
            "fax_number": "928-674-7705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "PATRICIA",
        "middle_name": "RENEE",
        "name_prefix": "Miss",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-13",
        "last_updated": "2013-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30.023852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alice A. Hopper, DPT
• Brian C. Hunter, PA-C, RD
• Indian Health Services (Chinle Hospital)
• Vladimir Ioffe, M.D.
• Manuel Luis Iravedra, D.M.D., B.S.PH
• Olubunmi A Jaiyeola Jr., PHARMD
• Carol Marie Jaworski, RDH
• Sherri Ann Joe, LISAC
• Britteny Johnson, RDN
• Peggy Johnson, OTR/L

• Dentist in Chinle, AZ
• Providers in Chinle, AZ by specialty
• Dentist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.