David K Jackson, PHD MSCP
Individual provider Active NPI Prescribing (Medical) Psychologist · New Orleans, LA
NPI 1053464339 · NPPES record last updated May 7, 2008
Key facts
- NPI
- 1053464339
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Prescribing (Medical) Psychologist 103TP0016X
- License
- 694MP (LA)
- Practice address
- 200 Henry Clay Ave
New Orleans, LA 70118-5911 - Phone
- (504) 896-7272
- NPI assigned
- Jan 19, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 694MP | LA | MD | Prescribing (Medical) Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Villa Feliciana Medical Complex | Past | Accepting new patients | |
| Villa Feliciana Medical Complex | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prescribing (Medical) Psychologist | 103TP0016X | 694MP | LA | Yes |
Addresses
Primary practice location
200 Henry Clay Ave
New Orleans, LA 70118-5911
Mailing address
200 Henry Clay Ave
New Orleans, LA 70118-5720
Phone (508) 896-7272
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1677833 | Medicaid | LA |
Other providers in New Orleans, LA
- Cadence Diane Jackson
- Chiquita Tanell Jackson
- Courtney Carol Jackson
- Crystal Jackson
- Cyrena Brown Jackson
- Deborah Maria Jackson
- Dlisa Jackson
- Domique Jackson
- Donna Marie Jackson
- Donna Michelle Jackson
All providers in New Orleans, LA · Prescribing (Medical) Psychologist in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 7, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.