Robert Joseph Jackson, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

PN270387 Issued in PA

Practice address

5454 East State St
Hermitage, PA 16148

Phone

(724) 346-2123

Fax

(724) 346-0366

NPI assigned

Jul 11, 2011

Sex

Male

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

Practice roles

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.

• Diversified Family Services, Inc.

  • Community/Behavioral Health Agency
  • Hermitage, PA
  • NPI 1891964193
  NPD (past)

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

{
    "created_epoch": "1310342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1310342400000",
    "number": "1447548573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1027",
            "address_2": "5454 EAST STATE STREET",
            "city": "HERMITAGE",
            "state": "PA",
            "postal_code": "161480027",
            "telephone_number": "724-346-2123",
            "fax_number": "724-346-0366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5454 EAST STATE ST",
            "city": "HERMITAGE",
            "state": "PA",
            "postal_code": "16148",
            "telephone_number": "724-346-2123",
            "fax_number": "724-346-0366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ROBERT",
        "middle_name": "JOSEPH",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-07-11",
        "last_updated": "2011-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "PA",
            "license": "PN270387",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cortney L Ifft, PA-C
• Iftikhar a. Chatha, MD, PC
• Chinedu Angela Ebere Igwe, M.D
• Heather J Ischo, FNP-C
• Jalen Jackson
• James R. Gebhart, D.O., PC
• Dennis C Javens, PT, SCS, ATC
• Jeanette Murray-Hall Counseling, Inc.
• Laurie Joanow, LCSW
• John Balko and Associates Inc

• Licensed Practical Nurse in Hermitage, PA
• Providers in Hermitage, PA by specialty
• Licensed Practical Nurse in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2011; 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.