Danette M. Jackson, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

DO-02419 Issued in IA

Practice address

BLDG 2245, 761St Tank Destroyer Blvd
Charles Thomas Moore Clinic
Ft Cavazos, TX 76544

Phone

(254) 285-6232

NPI assigned

Sep 6, 2006

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691971200000",
    "number": "1083717078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "590 MEDICAL CENTER ROAD",
            "city": "FT. CAVAZOS",
            "state": "TX",
            "postal_code": "76544",
            "telephone_number": "254-288-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BLDG 2245, 761ST TANK DESTROYER BLVD",
            "address_2": "CHARLES THOMAS MOORE CLINIC",
            "city": "FT CAVAZOS",
            "state": "TX",
            "postal_code": "76544",
            "telephone_number": "254-285-6232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DANETTE",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-06",
        "last_updated": "2023-08-14",
        "certification_date": "2023-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "DO-02419",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Precious Peace Itugbu
• David S Iverson, MD
• Myles Iwen, D.M.D.
• Aaron Jackson, M.D.
• Cody Jackson, DO
• Mark Lawrence Jacques, M.D.
• Woohyuck Jang, DO
• Dae Min Jeon, DDS
• Mallory Jayne Johnson, OD
• Mitchell Johnson

• Family Medicine Physician in Ft Cavazos, TX
• Providers in Ft Cavazos, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.