Sally Fayrweather Jackson, HRN

Primary specialty

Undersea and Hyperbaric Medicine (Emergency Medicine) PhysicianTaxonomy code 207PE0005X

License

12Z3145002055 Issued in AZ

Practice address

3303 E Baseline Rd Ste 108
Gilbert, AZ 85234-2739

Phone

(480) 590-5833

NPI assigned

May 24, 2023

Sex

Female

Sole proprietor

Yes

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

State licenses

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

{
    "created_epoch": "1684886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684886400000",
    "number": "1114619459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3303 E BASELINE RD STE 108",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852342739",
            "telephone_number": "480-590-5833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3303 E BASELINE RD STE 108",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852342739",
            "telephone_number": "480-590-5833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SALLY",
        "middle_name": "FAYRWEATHER",
        "name_prefix": "Ms.",
        "credential": "HRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-05-24",
        "last_updated": "2023-05-24",
        "certification_date": "2023-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0005X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Undersea and Hyperbaric Medicine",
            "state": "AZ",
            "license": "12Z3145002055",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacquelyn Lee Jackson, RN
• Jennica Jackson
• Lauryn Jackson, PA-C
• Macheri Jackson
• Mary Jackson, LPC
• Starnique Antrenae Jackson
• Tahji Jackson
• Beth Louise Jaco, CPNP
• Jacob Zuniga,DDS,LLC
• Allison Jacobs

• Undersea and Hyperbaric Medicine (Emergency Medicine) Physician in Gilbert, AZ
• Providers in Gilbert, AZ by specialty
• Undersea and Hyperbaric Medicine (Emergency Medicine) Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 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.