Active NPI
Jackie Lynn McDonald, RN, COHN-S, CAOHC
- Occupational Health Registered Nurse
- Tyler, TX
National Provider Identifier
1033556170
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Health Registered Nurse
- License
- 660165
- Practice address
- 11937 Hwy 271
Tyler, TX 75708-3154 - Phone
- (903) 877-5553
- NPI assigned
- May 30, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 660165 | TX | |
| Occupational Health Registered Nurse | 163WX0106X | 660165 | TX | Primary |
| Other Specialist/Technologist | 246Z00000X | 40275 |
Addresses
Primary practice location
11937 Hwy 271
Tyler, TX 75708-3154
Mailing address
11937 Hwy 271
Tyler, TX 75708-3154
Phone (903) 877-5553
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 660165 | Other | TX | RN |
| 40275 | Other | CAOHC | |
| 8922 | Other | COHN-S |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 660165 | TX | MD | Occupational Health Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1369872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1369872000000",
"number": "1033556170",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11937 HWY 271",
"city": "TYLER",
"state": "TX",
"postal_code": "757083154",
"telephone_number": "903-877-5553"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11937 HWY 271",
"city": "TYLER",
"state": "TX",
"postal_code": "757083154",
"telephone_number": "903-877-5553"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCDONALD",
"first_name": "JACKIE",
"middle_name": "LYNN",
"credential": "RN, COHN-S, CAOHC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-05-30",
"last_updated": "2013-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "TX",
"license": "660165",
"primary": false
},
{
"code": "163WX0106X",
"taxonomy_group": "",
"desc": "Registered Nurse, Occupational Health",
"state": "TX",
"license": "660165",
"primary": true
},
{
"code": "246Z00000X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other",
"state": null,
"license": "40275",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RN",
"identifier": "660165",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAOHC",
"identifier": "40275",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COHN-S",
"identifier": "8922",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.