Active NPI
Kristian B Jackson, RPH
- Pharmacist
- Indian TWP, ME
National Provider Identifier
1235388398
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PR5291
- Practice address
- 401 Peter Dana Point Rd
Indian TWP, ME 04668-5007 - Phone
- (207) 796-2321
- NPI assigned
- Sep 14, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 40346 | TX | |
| Pharmacist | 183500000X | PR5291 | ME | Primary |
Addresses
Primary practice location
401 Peter Dana Point Rd
Indian TWP, ME 04668-5007
Mailing address
PO Box 97
Princeton, ME 04668-0097
Phone (207) 796-2321
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 Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PR5291 | ME | MD | Pharmacist |
| 40346 | TX | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Indian Township Tribal Government | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Federally Qualified Health Center (FQHC)
- Princeton, ME
- NPI 1205952140
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1221350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649894400000",
"number": "1235388398",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 97",
"city": "PRINCETON",
"state": "ME",
"postal_code": "046680097",
"telephone_number": "207-796-2321"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 PETER DANA POINT RD",
"city": "INDIAN TWP",
"state": "ME",
"postal_code": "046685007",
"telephone_number": "207-796-2321"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KRISTIAN",
"middle_name": "B",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-09-14",
"last_updated": "2022-04-14",
"certification_date": "2022-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "40346",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ME",
"license": "PR5291",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indian TWP, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.