Active NPI
Donna Jackson, RDH
- Dental Hygienist
- Mount Vernon, MO
National Provider Identifier
1235403122
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 003465
- Practice address
- 558 E Mount Vernon Blvd
Mount Vernon, MO 65712-2102 - Phone
- (417) 466-7184
- Fax
- (417) 466-4081
- NPI assigned
- Feb 24, 2012
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 003465 | MO | Primary |
Addresses
Primary practice location
558 E Mount Vernon Blvd
Mount Vernon, MO 65712-2102
Mailing address
558 E Mount Vernon Blvd
Mount Vernon, MO 65712-2102
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003465 | MO | MD | Dental Hygienist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| J. Warren Hildreth, Jr DDS PC of Missouri | 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.
-
- General Practice Dentistry
- Mount Vernon, MO
- NPI 1952403040
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1330041600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1330041600000",
"number": "1235403122",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "558 E MOUNT VERNON BLVD",
"city": "MOUNT VERNON",
"state": "MO",
"postal_code": "657122102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "558 E MOUNT VERNON BLVD",
"city": "MOUNT VERNON",
"state": "MO",
"postal_code": "657122102",
"telephone_number": "417-466-7184",
"fax_number": "417-466-4081"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "DONNA",
"credential": "RDH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-02-24",
"last_updated": "2012-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "MO",
"license": "003465",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Vernon, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.